33 years old with Low Testosterone - What next?

[MisterC55]

Hi everyone,

The past few years I've been feeling all around shitty. My biggest complaints are depression, low energy, fatigue, constantly feeling tired, zero motivation, difficulty concentrating or making decisions. What really knocked me on my ass was about 4 years ago I started suffering from anxiety and panic attacks, which I have never felt before in my life. Ever since then every day is somewhat of a battle to get through. I'm mentally and physically exhausted.

So after feeling like I hit rock bottom, I made my rounds to psychiatrists trying to get to the bottom of the problem. Tried a couple of different antidepressants, none which have really helped at all. I'm still currently taking Paxil 20 mg/day which has definitely had a negative impact on my sex drive, very rare to get morning wood, softer erections, takes much longer to reach orgasm, etc.

Anyways, after more and more research I kept thinking low testosterone might be a possible cause. I have all of the symptoms, and in the past, even when I was extremely strict with my diet and had a great workout routine, it was really difficult to put on muscle or lose weight around my chest, stomach and love handles.

So I asked the doctor if I could be tested, he basically blew me off and said that there was no way I had low T, how it's difficult to practice medicine nowadays, etc. But he agreed to test anyways. Sure enough, it came back as 279 total Test (ng/dl) (Normal 300-1000). As we were looking over my bloodwork he was very surprised and said "yea we need to look into this". He ordered me back in for additional bloodwork (because I had eaten a handful of cashews before the last blood test), but this time checking also for free test and FSH? I asked if they can also check for Estradiol, but the clinician said he may not approve, but they would check with the doc.

One other thing I would like to mention. About 8 years ago I noticed some lumpiness on my left testicle. Went to the urologist and I'm pretty sure he said it was a varicocele, but after a sperm test was fine he said not to worry about it. I'm starting to worry that maybe this had an effect on my testosterone production? That doctor never tested my testosterone, only my sperm.

So as I wait to hear back about my second Blood test, I have made an appointment with a urologist, to check out the varicocele issue and obviously also discuss the low T.

Since I really appreciate the knowledge of this forum, I'm wondering if anyone has any thoughts or suggestions about a possible plan of action.

Thanks everyone for the help!

[Megalodon6]

Post your results when you get them post all of them that way these hormone gurus can see the whole picture.

[SweepTheLegJohnny]

You need to figure out whether it's primary or secondary hypogonadism before you go any further. You damn sure better make sure it's not testicular cancer of any kind first...

[MisterC55]

So I got the results back from my second blood test with primary doctor. I guess he didn't test for estradiol even though I requested it. Surprisingly, my total T was a little higher.

Here are the new numbers:

Total Testosterone - 396 (300-1000)
Free Testosterone - 12.8 (4.8 - 25.7)
FSH - 8.8 (1.4 - 11.4)

I also went to a urologist today and described the whole situation to him. He checked my testicles and didn't believe I had any varicocele. He agreed that 279 was very low but also cautioned about the consideration that has to be given to going on replacement therapy.

He ordered another blood test but he also will be testing for LH and Prolactin in addition to the Testosterone and FSH. I'll be sure to update once I receive the bloodwork results.

Any thoughts on this new bloodwork?

[kelkel]

Take a look in the HRT Forum's "Finding A Doc" sticky thread at the very top. Use the first set of BW there to fill in the blanks of what you missed. This way you can properly assess the situation.

[cantrellsp]

Hey Mister what time did you take your second blood test (the one that gave your 396)

[MisterC55]

cantrellsp - All three blood tests were taken at 9 am.

Just got my latest bloodwork results.

Total Test - 337 (300-1080)
Prolactin - 7.1 (3.0 - 30.0)
FSH - 8.3 (no range provided)
LH - 2.8 (no range provided)

I guess this doesn't provide any additional data? It seems like it just confirms that my total testosterone is always low.

I took a look at the list of bloodwork recommended. How should I go about trying to convince the doctor to test for all of these things? If he thought they were necessary, wouldn't he have ordered those tests originally? Should I try and see an endocrinologist instead?

Any advice is appreciated. Thanks!

[cantrellsp]

Mister,

Here is my opinion so take it with a grain of salt. I have been going down this road for about 3 years now looking for the right answers as to what I should or should not do. I can tell you in my journey I started out at 330-315 thinking I was low test which also mentally made me think I needed something extra. I can tell you in over 3 years most people I have meet are between 224 and 350 total test with the occasional 400 range, but I have never met anymore that has just 1000 range natural testosterone . I honestly think the range is not accurate and test is being overly prescribed. Like I said I am not a doctor so this is just my opinion. are you going to feel great on test... absolutely. you are taking steroids your going to feel great. I was in the 290 range when the doctor gave me test. I did it for about 6 mths straight and then quit cold turkey. My levels went back up to there original levels with no pct at all. You have great levels in my opinion and I would not mentally jack my self up thinking they were low. now, if you want to take a cycle just to get some size and take yourself to the next level then by all means do a cycle, but I wouldnt want to be stuck on test forever with levels like yours. just my thoughts

[MisterC55]

Mister,

Here is my opinion so take it with a grain of salt. I have been going down this road for about 3 years now looking for the right answers as to what I should or should not do. I can tell you in my journey I started out at 330-315 thinking I was low test which also mentally made me think I needed something extra. I can tell you in over 3 years most people I have meet are between 224 and 350 total test with the occasional 400 range, but I have never met anymore that has just 1000 range natural testosterone. I honestly think the range is not accurate and test is being overly prescribed. Like I said I am not a doctor so this is just my opinion. are you going to feel great on test... absolutely. you are taking steroids your going to feel great. I was in the 290 range when the doctor gave me test. I did it for about 6 mths straight and then quit cold turkey. My levels went back up to there original levels with no pct at all. You have great levels in my opinion and I would not mentally jack my self up thinking they were low. now, if you want to take a cycle just to get some size and take yourself to the next level then by all means do a cycle, but I wouldnt want to be stuck on test forever with levels like yours. just my thoughts

Do you really think that 279 or 337 is normal for a 33 year old?

[kelkel]

Mister,

Here is my opinion so take it with a grain of salt. I have been going down this road for about 3 years now looking for the right answers as to what I should or should not do. I can tell you in my journey I started out at 330-315 thinking I was low test which also mentally made me think I needed something extra. I can tell you in over 3 years most people I have meet are between 224 and 350 total test with the occasional 400 range, but I have never met anymore that has just 1000 range natural testosterone . I honestly think the range is not accurate and test is being overly prescribed. Like I said I am not a doctor so this is just my opinion. are you going to feel great on test... absolutely. you are taking steroids your going to feel great. I was in the 290 range when the doctor gave me test. I did it for about 6 mths straight and then quit cold turkey. My levels went back up to there original levels with no pct at all. You have great levels in my opinion and I would not mentally jack my self up thinking they were low. now, if you want to take a cycle just to get some size and take yourself to the next level then by all means do a cycle, but I wouldnt want to be stuck on test forever with levels like yours. just my thoughts

Note that testosterone is bio-identical to what your body endogenously produces. You were in the 290 range for serum T. Without knowing your free T level that number is useless, other than the fact that if TT is low then FT will naturally be low as well. The testosterone range is developed from a wide spectrum of people of all age groups, with obviously the youngest having the higher levels. The insurance industry has a hand in this as well.

I'm guessing your doctor did not fully explore why your testosterone was low. Which is not surprising as most doc's do not know hormones and are not trained in them in med school. I agree with your comment that too many men are being prescribed testosterone. It's simply due to doctors not understanding or taking the time to search for a causative factor and correct it. Instead it's easier for them to slap gel on them or another form of test and hope for the best.

Re your protocol lasting six months, know that for many men it can take at least that amount of time or up to a year to be fully dialed in. It also depends on the quality of care and knowledge the doc puts forth. Also, I can't really say going back to your old levels is any type of win-win. Eventually your levels will decline even more. At what point will you go back to TRT? Remember, you're not a number and should be treated based on how you feel.

Do you really think that 279 or 337 is normal for a 33 year old?

I surely do not. Consider picking up Testosterone for Life by Abraham Morgantaler or Testosterone, A Man's Guide by Nelson Vergel. Great reads that can help you a lot.

[kelkel]

cantrellsp - All three blood tests were taken at 9 am.

Just got my latest bloodwork results.

Total Test - 337 (300-1080)
Prolactin - 7.1 (3.0 - 30.0)
FSH - 8.3 (no range provided)
LH - 2.8 (no range provided)

I guess this doesn't provide any additional data? It seems like it just confirms that my total testosterone is always low.

I took a look at the list of bloodwork recommended. How should I go about trying to convince the doctor to test for all of these things? If he thought they were necessary, wouldn't he have ordered those tests originally? Should I try and see an endocrinologist instead?

Any advice is appreciated. Thanks!

Well, the Labcorp range for LH is around 1.5 to 9 from memory. That puts your level at the low end of the spectrum, thus low T. Basically a weak signal from your pituitary to your testicals, or secondary hypogonadism. Key here is to find out if something else is suppressing it. You've ruled out prolactin. Cortisol can suppress it as can thyroid issues. Hypothyroidism is a main cause of hypogonadism. Pathologies can do it as well as trauma.

You need to request your doctor fill in the blanks with the other items you need to test to try and determine what's suppressing your LH function. If he does not agree I'd be looking for a more knowledgeable doctor as it may be beyond his level of hormone knowledge. Some doc's will take incremental steps with blood work which is fine. Others just don't understand it. When it comes to doctors, title really doesn't matter, just that they know hormones. If I were to choose a title it would be Urologist.

Hope it helps.

[cantrellsp]

Hey guys,

I am 31 so naturally all of my friends around me are in the same age. I have been in the gym since I was 15 so most of my friends are meat heads and have done a cycle at some point. Again, I am not doctor I am just going off my own personal experience. Everyone I have talked to about test levels have been in that range of 250-350 my age. The one guys I talked to that was 26 years old had 450 and the doctor tried to tell him he was low and wanting to put him on HRT. I completely agree with KelKel about we are not a number and should do what makes us feel better. My only worry is all of our men in this country are going to be medical prescribed to test. I am not against test. I do cycles and then cycle off. I dont like the thought of my testes not producing year round. like I said just my opinion

Kelkel I had posted my results asking for advice and never got any post back. If you get time check it out and let me know what I am missing. Thanks and you guys have a great day

[InternalFire]

from my experience, someone comes in and asks a question:
XX years old with Low Testosterone - What next?

The answer usually goes like this:

- HIGH TESTOSTERONE

(just good mood today...)

[kelkel]

Hey guys,

I am 31 so naturally all of my friends around me are in the same age. I have been in the gym since I was 15 so most of my friends are meat heads and have done a cycle at some point. Again, I am not doctor I am just going off my own personal experience. Everyone I have talked to about test levels have been in that range of 250-350 my age. The one guys I talked to that was 26 years old had 450 and the doctor tried to tell him he was low and wanting to put him on HRT. I completely agree with KelKel about we are not a number and should do what makes us feel better. My only worry is all of our men in this country are going to be medical prescribed to test. I am not against test. I do cycles and then cycle off. I dont like the thought of my testes not producing year round. like I said just my opinion

Kelkel I had posted my results asking for advice and never got any post back. If you get time check it out and let me know what I am missing. Thanks and you guys have a great day

It is sad and a lot of it has to do with lifestyle. Fast food, obesity, the acceptance of obesity as a disease by the FDA and so many other things that contribute to the decline of testosterone in males.

cantrellsp I'll search it up! Sorry I missed it.

[MisterC55]

Hi everyone,

Thanks so much for all of the help!

I just got back from a pretty disappointing appointment with my urologist. We went over my last results:

Total Test - 337 (300-1080)
Prolactin - 7.1 (3.0 - 30.0)
FSH - 8.3 (1.3 - 11.4)
LH - 2.8 (1.2 - 7.8)

He basically told me that I was within the normal range, even though I was on the low end of normal. I asked about doing other blood tests to find the root of the problem and he said that there wasn't anything else to test for. Obviously, after reading this forum, I know that is not accurate.

It sounded like he was open to the idea of starting me on TRT but also mentioned we could try Clomid. I expressed my hesitations about TRT being a lifelong process. He wrote me a prescription for Clomid (25 mg) per day. He said that it could be effective for raising my test levels. He also said that it's not a long term option really and that once I stop taking it, my levels will go back down. I'm not really sure what good it will do to raise my levels, to have them go back down.

As of now, the plan is probably to find a new doctor who is willing to do some more bloodwork to get to the root of the problem. Does anyone have any thoughts about me starting the Clomid? I guess it would be nice to see if it worked, but then what? Are there any disadvantages to taking it?

I'm not really sure to go from here other than finding a new doc. Just wondering if it is a good idea to start the Clomid or not.

Thanks guys...

[kelkel]

Any thyroid levels by chance? Hypothyroidism is a major cause of Hypogonadism.....

Re clomid. It's an effective therapy for T replacement as long as the patient is not primary hypogonadal. Read these:

Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency - a prospective study. - PubMed - NCBI

Outcomes of clomiphene citrate treatment in young hypogonadal men. - PubMed - NCBI

[MisterC55]

Any thyroid levels by chance? Hypothyroidism is a major cause of Hypogonadism.....
]

I just called my previous doctor and he tested for:

TSH 1.0 (0 5 to 5.0)

They also said a comprehensive metabolic panel was done and everything was normal.

I've read a good amount about the clomid, but my biggest concern is that it seems that a lot of men have experienced anxiety and depression on it. I already have both of those, so I would hate to add Clomid and make it even worse.

I'd like to get more bloodwork done to get the the root of the problem, but clearly this Dr. doesn't want to do that. I'm just wondering if the clomid might help to restart my HPTA axis? Also wondering if I should give it a shot now, or try a new doc and get more bloodwork done before.

[kelkel]

Well, it can easily be the opposite as well when it comes to anxiety and depression. They are more common in men "with" low testosterone . Reversing it via clomid therapy can help alleviate those issues. Now granted, many things can cause those specific sides as well.

Initiating clomid will not hurt you imho. It simply tricks your hypothalamus into thinking there's no estrogen thus it ramps up production of LH / FSH via the pituitary. May be worth a shot for you.

[MisterC55]

Yea, I think at this point it sounds like it might be worth a shot. I'd like to at least test a few more of the levels before I start with the Clomid.

I'm thinking of possibly going for some more bloodwork, and paying myself for some tests since this Doctor doesn't feel the need for any more tests. Since I'll be paying for the BW myself I can only test for a few things. What would be some good things to test for?

I was thinking it might be wise to do the estradiol (sensitive test) and SHBG? Or is there anything else that I should consider that might help me figure out what the actual cause of the low T is?

[MisterC55]

So I went ahead and got some bloodwork done on my own. Unfortunately, I had the lowest level yet of testosterone . Listed below are the different panels and their results.

Any additional thoughts? Thanks everyone!

Testosterone,Free and Total
Testosterone, Serum 154 ng/dL (348 - 1197) (low)
Free Testosterone (Direct) 4.9 pg/mL (8.7 - 25.1) (low)
DHEA-Sulfate 181.4 ug/dL (138.5 - 475.2)
Estradiol, Sensitive 11.3 pg/mL (8.0 - 35.0)
Sex Horm Binding Glob, Serum 12.4 nmol/L (16.5 - 55.9) (low)

CBC With Differential/Platelet
WBC 6.5 x10E3/uL 3.4 - 10.8
RBC 5.15 x10E6/uL 4.14 - 5.80
Hemoglobin 15.9 g/dL 12.6 - 17.7
Hematocrit 49.3 % 37.5 - 51.0
MCV 96 fL 79 - 97
MCH 30.9 pg 26.6 - 33.0
MCHC 32.3 g/dL 31.5 - 35.7
RDW 13.2 % 12.3 - 15.4
Platelets 205 x10E3/uL 150 - 379
Neutrophils 58 %
Lymphs 32 %
Monocytes 7 %
Eos 2 %
Basos 1 %
Neutrophils (Absolute) 3.7 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 2.1 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.4 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.2 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.1 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1
Comp. Metabolic Panel (14)
Glucose, Serum 89 mg/dL 65 - 99
BUN 13 mg/dL 6 - 20
Creatinine, Serum 1.06 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 92 mL/min/1.73 >59
eGFR If Africn Am 106 mL/min/1.73 >59
BUN/Creatinine Ratio 12 8 - 19
Sodium, Serum 141 mmol/L 134 - 144
Potassium, Serum 4.2 mmol/L 3.5 - 5.2
Chloride, Serum 100 mmol/L 97 - 108
Carbon Dioxide, Total 27 mmol/L 18 - 29
Calcium, Serum 9.9 mg/dL 8.7 - 10.2
Protein, Total, Serum 7.4 g/dL 6.0 - 8.5
Albumin, Serum 4.9 g/dL 3.5 - 5.5
Globulin, Total 2.5 g/dL 1.5 - 4.5
A/G Ratio 2.0 1.1 - 2.5
Bilirubin, Total 0.4 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 76 IU/L 39 - 117
AST (SGOT) 12 IU/L 0 - 40
ALT (SGPT) 11 IU/L 0 - 44

[kelkel]

No LH on this set or am I missing it? If you can rule out thyroid, prolactin and cortisol I'd probably be curious about an MRI of your pituitary to rule out any abnormalities. Other than that, I'd say it's time to start clomid.

[MisterC55]

No, there was no LH tested this time.

How can I "rule out" thyroid, prolactin and cortisol?

I already checked for the TSH (and the urologist said there was nothing else to test for. (which is why I paid for the last set of tests on my own) The levels listed below are from different tests.

TSH 1.0 (0 5 to 5.0)
Prolactin - 7.1 (3.0 - 30.0)

I'm actually sending out a 4/day saliva cortisol test on Monday. That will actually check for test, progesterone, E2 and DHEAS. I figured if anything I can get a saliva reading.

I'm just surprised at how low my last Total T was at 154, considering I have been hovering around the 300 mark. I might even spend the 30 bucks and test again this week just to be sure.

[MisterC55]

So after meeting with a new doctor who seems to do more work with hormones/TRT, here is my latest bloodwork...


TOTAL TESTOSTERONE 252 300-1080 NG/DL (low)
SEX HORM BIND GLOBULIN 12 16.5-55.9 NMDL/L (low)
CALC FREE TESTOSTERONE 7.7 4.8-25.7
DHEA SULFATE 135 103-446 UG/DL (in range but Dr wants 400)
VITAMIN D 34 (Optimal 30-100) (in range but Dr wants 60-80)

TSH 1.3 0.5-4.7 UIU/ML
FREE T3 2.5 2.3-4.2 PG/ML (in range but Dr. wants >3.5)
FREE T4 (THYROXINE) .96 0.73-1.95 NG/DL
ESTRADIOL 23 <=63 PG/ML

HOMOCYSTEINE 13.4 H 5.0-12.0 UMDL/L (high)
INSULIN 15 4-13 UIU/ML (high)
PSA, TOTAL 0.5 <4.0 NG/ML

Metabolic Panel and Lipid Profile
GLUCOSE 83 65-100 MG/DL
BUN 16 8-25 MG/DL
CREATININE 0.98 0.80-1.40 MG/DL
eGFR AFRICAN AMER. 117 >60 ML/MIN/l-73
eGFR NON-AFRICAN AMER. 101 >60 ML/MIN/1.73
CALCULATED BUN/GREAT 16 6-28 RATIO
SODIUM 139 133-146 MEQ/L
POTASSIUM 4.3 3.5-5.3 MEQ/L
CHLORIDE 103 97-110 MEQ/L
CARBON DIOXIDE 23 18-30 MEQ/L
CALCIUM 9.7 8.5-10.5 MG/DL
CHOLESTEROL 182 <200 MG/DL
TRIGLYCERIDES . 169 H <150 MG/DL (high)
HDL CHOLESTEROL 51 >39 MG/DL
CALCULATED LDL CHOL 97 <100 MG/DL
RISK RATIO LDL/HDL 1.91 <3.55 RATIO
PROTEIN, TOTAL 7.0 6.0-8.4 G/DL
ALBUMIN 4.4 2.9-5.0 G/DL
CALCULATED GLOBULIN 2.6 2.0-3.8 G/DL
CALCULATED A/G RATIO 1.7 0.9-2.5 RATIO
BILIRUBIN, TOTAL 0.6 0.1-1.3 MG/DL
ALKALINE PHOSPHATASE 65 30-132 U/L

SGOT (AST) 13 5-35 U/L

SGPT (ALT) 12 7-56 U/L

WBC 5.2 4.0-11.0 K/UL
RBC 4.94 4.10-5.70 M/UL
HEMOGLOBIN 15.4 13.0-17.0 G/DL
HEMATOCRIT 44.5 37.0-49.0 %

MCV 90.1 80.0-100.0 fL
MCH 31.2 27.0-34.0 PG
MCHc 34.6 32.0»35.5 G/DL
RDW 13.2 11.0-15.0 %
NEUTROPHILS 58 40-74 %
LYMPHOCYTES 31 19-48 %
MONOCYTES 8 4-13 %
EOSINOPHILS 3 057 %
BASOPHILS 0 0-2 %

PLATELET COUNT 202 130-400 K/UL

So after these results, the Doctor wrote me a prescription for Nature Throid 1 grain, since he said my T3 is low. He also told me to supplement with DHEA and 10,000IU of Vitamin D3 per day.

I have a difficult time believing that two supplements with the Nature Throid is going to help solve my problem. I'm due for follow up blood work in about another month. It seems like he wants to try this and then push for the TRT, which I'm not ready for yet.

At this point I'm thinking of sticking with the Nature Throid, Vitamin D and giving the Clomid a shot. I'll start with very low 12.5 mg / day since I have read that it might be more effective (less sides) and plus I can always increase.

Any thoughts? All of your help is appreciated!!!

[kelkel]

You rule out thyroid, prolactin and cortisol by blood work.
Again, no LH/FSH tested. Is your doc just assuming they're low?
Looking at your thyroid numbers you may be secondary hypothyroid, which will impact LH levels and thus T production. How much is anyone's guess.
I still think it's pituitary related as well as I'd think your TSH would be higher in effort to stimulate an under-active thyroid, but it's not.
Good on the Vit D. Just always monitor levels and take it with a large meal. It's fat soluble and is absorbed better this way. I do 10K myself as well.
If you're not taking a good amount of fish oil for your triglycerides, do so immediately. If you are, you should probably increase the dose.
If you're going to take DHEA you may as well take Preg also. Make sure both are micronized products.
If if comes to it, I'd probably opt for clomid first as well. Then after a time come off and see if levels remain improved.

[MisterC55]

Thanks kelkel.

I've had FSH tested twice, but LH only once.

FSH - 8.8 (1.3 - 11.4)

FSH - 8.3 (1.3 - 11.4)
LH - 2.8 (1.2 - 7.8)

I did a Saliva Cortisol test and everything came back normal, except for my 5pm reading which was a little high. Oddly enough, the saliva test said I had high DHEA, which is the exact opposite of what the blood tests are saying.

I'll speak with the doc about possibility of checking for pituitary abnormalities.

I stopped taking fish oil but I can definitely start again.

[Blazini]

How are things going now? Any research into correcting the varicocele to see if test levels increase?

[MisterC55]

Hey Blazini,

Thanks for asking. The urologist said that I didn't have any varicocele and if it was, it was very minor.

I've just started on some very low dose Clomid which has raised my Total T to 725. Unfortunately, I"m not really feeling any better. Not yet anyways. It's only been about 4 weeks so maybe it will take some time?

I'm a little busy now, but once I have some time I am going to post up my most recent bloodwork!