20 YO with Low Testosterone, Need some advice

[Hydrophile]

Hey guys. I went in to the endocrinologist because of constant fatigue, very mild gyno (did an ultrasound for the sake of it, there is hardly anything there but it does cause nipple puffiness), and the fact that I'm 20 and cannot grow facial hair. Turns out I have low testosterone. I have never used steroids so that is not the cause.

(I also found out lack of focus is a symptom of low T. I had been put on Adderal for ADHD a while ago but it didn't help all that much, maybe this explains the root cause.)

How do these levels look? (all I know if 298 testosterone is not right for a 20 year old male):

COMMONRM BIND GLOB ------------ 35 nmol/L --------------- 16 - 70 nmol/L
TESTOSTERONE -------------------- 298 ng/dl ---------------- 200 - 745 ng/dl
TESTOSTERONE, FREE ------------- 5.7 ng/dl ---------------- 3.1 - 12.8 ng/dl
TESTOSTERONE, BIOAV ----------- 133.0 ng/dl -------------- 71.7 - 300.0 ng/dl

IGF I ---------------------------------- 318 ng/mL -------------- 83 to 456 ng/mL
Z SCORE, MALE --------------------- 0.6 SD -------------------- NEG 2.0 to +2.0 (Unit: SD)

CORTISOL (11:30 AM) ------------- 15 mcg/dl ---------------- AM (Before 1200): 4-23, PM (After 1200): 2-14

PROLACTIN ------------------------- 15.1 ng/ml ---------------- 3.7 - 17.9 ng/ml

ESTRADIOL ------------------------- 12 pg/ml ------------------ 6 - 65 pg/ml

T4, FREE ---------------------------- 0.9 ng/dl ----------------- 0.8 - 2.2 ng/dl

TSH, SENSITIVE ------------------- 4.152 uIU/ml ------------- 0.300 - 5.000 uIU/ml

FSH --------------------------------- 3.2 mIU/ml --------------- 1.6 - 9.7 mIU/ml

LH ---------------------------------- 3.8 mIU/ml ---------------- 1.2 - 7.8 mIU/ml

I have a few questions:

- Along with TRT, what other medications will I need to be put on? SERM, AI, or anything else?

- What level of testosterone am I supposed to be shooting for? I want to know this so I don't end up on too low of a dose.

[kelkel]

Hello Hydro. Edit and add some ranges for us please.

Just looking at your TSH level it's indicative of Hypothyroidism which will cause Hypogonadism. Any TSH level over 2 should really be looked at and you're way past that. A more modern range for TSH is 0.3 -3.0 BTW.

Take some time and do some reading at www.stopthethyroidmadness.com and self-educate. You really don't want to be on TRT at your age. Find what the actual cause is (hypothyroid, whatever it may be) and fix it. Don't band aid it. It's very doubtful that it's idiopathic at your age.

[Hydrophile]

Hello Hydro. Edit and add some ranges for us please.

Just looking at your TSH level it's indicative of Hypothyroidism which will cause Hypogonadism. Any TSH level over 2 should really be looked at and you're way past that. A more modern range for TSH is 0.3 -3.0 BTW.

Take some time and do some reading at URL and self-educate. You really don't want to be on TRT at your age. Find what the actual cause is (hypothyroid, whatever it may be) and fix it. Don't band aid it. It's very doubtful that it's idiopathic at your age.

Thanks very much. I will read up on that.

Do you know soon would I see improvements in energy and testosterone with the thyroid treatment? (Not that I'm going to try to get a quick fix over the correct course of action, just wondering)

I will add ranges soon.

[kelkel]

Yes, it does not take long for thyroid meds to work, if that's what ends up being needed. Correcting a potential thyroid issue will elevate your T level and result in various quality of life improvements.

[Lee_1978]

I'd like to add that being hypogonadal can be symptomatic of many different issues. Thyroid meds can help to correct androgen levels, but judging by your figures, I'm not sure if it can increase levels to a significant degree? I was diagnosed with hypothyroidism (my TSH was greatly elevated) and my testosterone levels were on the higher end of normal and this hasn't changed since commencing medication.

If you do start TRT, depending on your prescribed dose, you should see improvements within 2 weeks, however, many people seemingly become 'immune' to thyroid meds and end up suffering from the symptoms they had pre-medication.

I would encourage you to get a full blood test for the following - TSH/Total T4/Free T4/Free T3 and an thyroid anti-body test, which will determine if you have an auto immune condition. These tests, albeit difficult to obtain, will give you a more thorough snap shot of your health, and then you can go about seeking the necessary treatment.

[SlimmerMe]

Yep re: TSH. Just in case you're not familiar. TSH is read inversely. High means low and low means high.

SM

[bullshark99]

Is that IGF a typo?? 318 a nice high number...

[Hydrophile]

[Something is setting off the spam filter]

What was your TSH level?

The only things I wasn't tested for that you listed are Free T3 and thyroid anti-body.

My mother did have kidney failure due to auto immune conditions. Can auto immune cause the issues I am seeing?

Yep re: TSH. Just in case you're not familiar. TSH is read inversely. High means low and low means high.

SM

Thanks that helps.

Is that IGF a typo?? 318 a nice high number...

No that's correct. Is it a good thing?

[Hydrophile]

[I've added ranges to my test results. They also did a Liver Panel, Basic Metabolic Panel, and Hemogram/PLTS/DIFF. Let me know if I should add those.]

Just talked to the doctor. I mentioned that I felt my testosterone was low and TSH high which could indicate hypothyroidism. This is what I got:

Blood work did not reveal any endocrine abnormality to explain symptoms

-blood count, kidney function, liver enzymes are in the normal range
- thyroid function, prolactin, testosterone, cortisol in the normal range
-growth hormone normal range

-breast ultrasound, showed benign gynecomastia ( enlarged breast tissue)

Most providers prescribed tamoxifen over raloxifene, because there is not a lot of data with raloxifene.
So can try 3 month trial of tamoxifen 10 mg twice daily to see whether improvement of symptoms

tamoxifen can decrease glandular tissue, but it does not always resulte in complete resolution of the gynecomastia
This is a non FDA indication for tamoxifen
Adverse events in men taking tamoxifen are rare, but include epigastric distress and possible increase risk for blood clots in lower extremity or lung.

So
Tamoxifen 10 mg twice daily for 3 months, follow up with endocrinology in 3 months
Repeat thyroid function test in 6 months ( TSH was in the upper range of normal)

So basically I got hit with the "normal range" BS. What should I do?

[bullshark99]

Yes solid, I was thinking a different lab but regardless it's solid.

[Hydrophile]

Yes solid, I was thinking a different lab but regardless it's solid.

Well at least I've got one thing going for me.

[kelkel]

[I've added ranges to my test results. They also did a Liver Panel, Basic Metabolic Panel, and Hemogram/PLTS/DIFF. Let me know if I should add those.]

Just talked to the doctor. I mentioned that I felt my testosterone was low and TSH high which could indicate hypothyroidism. This is what I got:



So basically I got hit with the "normal range" BS. What should I do?

Are you in the states and able to pull BW on your own? Also Tamox is fine in lieu of Ralox. The statistical difference in efficacy is insignificant.

[Mr.BB]

So basically I got hit with the "normal range" BS. What should I do?

I would tell her that I could have seen that numbers were inside the ranges myself, and ask if she had to go through so many years of medical school just to see that?




Im not a very patient person...

[Hydrophile]

Are you in the states and able to pull BW on your own? Also Tamox is fine in lieu of Ralox. The statistical difference in efficacy is insignificant.

Sorry, what is BW? Yes I'm in US.

Good to know about the Tamoxifen thank you.

I would tell her that I could have seen that numbers were inside the ranges myself, and ask if she had to go through so many years of medical school just to see that?




Im not a very patient person...

That's definitely how I feel but I don't know if it will help me out very much calling it out. If that's what she believes to be true there's no way for me to change her mind. :/

[Lee_1978]

What was your TSH level?

The only things I wasn't tested for that you listed are Free T3 and thyroid anti-body.

My mother did have kidney failure due to auto immune conditions. Can auto immune cause the issues I am seeing?



Thanks that helps.



No that's correct. Is it a good thing?

My TSH was 45, which is crazily high.

[Mr.BB]

My mother did have kidney failure due to auto immune conditions. Can auto immune cause the issues I am seeing?

Read about Hashimotos, although its not a kidneys disease.

[Hydrophile]

How do I proceed? Should I be looking for physicians, endocrinologists, or TRT clinics?

Read about Hashimotos, although its not a kidneys disease.

I don't have any of the symptoms.

[thisAngelBites]

Your lack of focus and constant fatigue are both signs of thyroid problems, and Hashimoto's is an autoimmune disorder where your body attacks cells in the thyroid, and lowers thyroid levels. So two of your symptoms could be due to Hashimoto's. but you wouldn't know if it is hypothyroidism or Hashimoto's without checking to see if you have antibodies that attack your thyroid in your blood.

How do I proceed? Should I be looking for physicians, endocrinologists, or TRT clinics?



I don't have any of the symptoms.

[Mr.BB]

I don't have any of the symptoms.

Im confused, in your first post you start talking about constant fatigue

[dchris17]

good to know

[Hydrophile]

Your lack of focus and constant fatigue are both signs of thyroid problems, and Hashimoto's is an autoimmune disorder where your body attacks cells in the thyroid, and lowers thyroid levels. So two of your symptoms could be due to Hashimoto's. but you wouldn't know if it is hypothyroidism or Hashimoto's without checking to see if you have antibodies that attack your thyroid in your blood.

What is this blood test called?

Do swollen lymph glands have anything to do with this? I have about 4 swollen nides around my crouch. They've been there for at least a year.

Im confused, in your first post you start talking about constant fatigue

Well I mean any of the other common symptoms besides fatigue. Fatigue seems to be a symptom of many, many things.

[Mr.BB]

Swollen lymph nodes, as well as low testosterone, is an indication that something is wrong in your body.
See, low testosterone is not a disease, not at your age, it is a symptom caused by some other condition, which you and your doctor needs to diagnose.

[Hydrophile]

Swollen lymph nodes, as well as low testosterone, is an indication that something is wrong in your body.
See, low testosterone is not a disease, not at your age, it is a symptom caused by some other condition, which you and your doctor needs to diagnose.

I agree, but my doctor refuses to accept that I have low testosterone or thyroid problems. I need some advice on what type of doctor will acknowledge these problems and treat me.

[Mr.BB]

So, there is only this one doctor where you live???

[Hydrophile]

So, there is only this one doctor where you live???

That's not what I said at all. Should I go to another endocrinologist? Should I see a general physician? Who is most likely going to understand my symptoms and give me treatment.

[Mr.BB]

Yes, go to a new doctor.

Talk to your GP, explain, try to get a referral for endocrinologist that specializes in thyroid. Ask for blood work refered above. If that not help, call clinics and doctors and say you are looking for thyoid specialist, etc

[Hydrophile]

So I was talking to my mom and she mentioned that her endocrinologist thinks she may have hashimotos.

What is the name of this thyroid anti body test so I know what to ask for?

[Mr.BB]

Lee mentioned above, its just thyroid antibody test, your doctor can easily prescribe it with this new information.

Genetic predisposition is big on Hashimoto's.

[Lee_1978]

Definitely source a new GP, even though with a new specialist you may still encounter indifference. Endocrinologists are notorious for pulling bloods, diagnosing a patient with hypothyroidism and then shutting them up with a life-long prescription of T4, and as I've previously stated there are other factors to consider when your thyroid hormones are low. But it is imperative that you have a full thyroid and androgen panel done with an Hashimoto's anti body test to determine the issue. Women are disproportionately affected with auto immune diseases like hypothyroidism and it is thought that oestrogen plays a major role in this, but due to modern lifestyles, stress and harmful toxins used in manufacturing plastics and man made products there has been a huge surge in the numbers of men acquiring the condition. Seek a professional, sympathetic medical ear, get tested and get treated - it's an agonising and exhausting condition to have, but you've come to the right place for advice. Keep us in the loop.

[Hydrophile]

Women are disproportionately affected with auto immune diseases like hypothyroidism and it is thought that oestrogen plays a major role in this, but due to modern lifestyles, stress and harmful toxins used in manufacturing plastics and man made products there has been a huge surge in the numbers of men acquiring the condition. Seek a professional, sympathetic medical ear, get tested and get treated - it's an agonising and exhausting condition to have, but you've come to the right place for advice. Keep us in the loop.

My estrodial is 12 pg/ml. Didn't think that was high but I haven't looked into it.

[Hydrophile]

Here are my communications with endo.

Since you last saw me, my mother's endocrinologist believes she may have Hashimoto's and going to be being tested for it. This is often hereditary, as I'm sure you know, and may explain my fatigue, TSH, swollen lymph nodes, swollen feeling in throat, and low testosterone. Although my testosterone is technically within range, my research indicates that it is not at an optimal level for a healthy, 20 year old male.

Can you please prescribe me with the following blood tests:

Free T3
TSH
anti-TPO
TgAb

(Did I miss any tests?)

Doc:

Labs ordered, we have faxed the lab slip to the requested lab.
Even though your thyroid function was in the normal limit when checked last, TSH was in the upper limit of normal (ie over 3), if TSH remains higher than 3, it would not be unreasonable to try low dose thyroid hormone replacement

[kelkel]

Have you ever looked into Selenium and Iodine? Just curious. Google Dr. Jeffrey Dach re both of them..

[CSI007]

I just saw this thread.

I don't want to alarm you but are your Doctors taking the enlarged lymph nodes in your groin seriously? Rarely are enlarged lymph nodes in the groin area something to be ignored. Your fatigue could also be a symptom of a something much more serious then low T or hypothyroidism.

[Hydrophile]

Have you ever looked into Selenium and Iodine? Just curious. Google Dr. Jeffrey Dach re both of them..

I will check it out.

I just saw this thread.

I don't want to alarm you but are your Doctors taking the enlarged lymph nodes in your groin seriously? Rarely are enlarged lymph nodes in the groin area something to be ignored. Your fatigue could also be a symptom of a something much more serious then low T or hypothyroidism.

Most of the signs are pointing to hashimotos now that I've looked into it more. I have swollen glands in my throat as well which is more related to hashimotos.

[CSI007]

Are the lymph-nodes in your groin painful to the touch?

Lymphdenoapthy in the clavicle, armpits and groin are highly suspicious for malignancy. I chased an enlarged lymph-node in my neck for almost 6 months before I got the correct diagnosis. I knew what it was but some of the doctors did not seem to care. If it were me, I would want a biopsy for any enlarged lymph-nodes in my body that did not resolve without 4 to 6 weeks. Having them for a year is scary.

I have hashimotos too.

[Hydrophile]

Are the lymph-nodes in your groin painful to the touch?

Lymphdenoapthy in the clavicle, armpits and groin are highly suspicious for malignancy. I chased an enlarged lymph-node in my neck for almost 6 months before I got the correct diagnosis. I knew what it was but some of the doctors did not seem to care. If it were me, I would want a biopsy for any enlarged lymph-nodes in my body that did not resolve without 4 to 6 weeks. Having them for a year is scary.

I have hashimotos too.

No not painful. I have at least four of them there and quite a few in my throat area.

Were your enlarged lymph nodes related to hashimotos? What test did they run with the biopsy?

[CSI007]

Non painful lymph nodes are not usually a good sign. When you say your throat what area are you talking about?

I had a single enlarged lymph node in my clavicle area of my neck it. The CT showed it was about 3CM in size. It was non painful. After I was finally diagnosed and had staging done it was determined that my cancer had likely started in my chest near the heart and progressed to the neck. I had lesions on both sides of my neck but only the left side had noticeable enlargement.

For the biopsy, I had a CT guided needle biopsy performed and it came back negative. But I was getting very sick with flu like symptoms among other things. So a week later I went to a surgeon and had an excisional biopsy done which required a slice of the lymph node to be taken out and looked at by pathology. They place it under a high powered microscope and look for any problems. For me, they found nodular sclerosing cells (Hodgkin's Lymphoma)

I was just recently diagnosed with hashimotos and the antibodies were not extremely elevated so it's probably not been going on for a very long time.

Through my research and talking to doctors who specialize in this area. Lymphodenapathy can be caused by infection and some other disease processes but often time there is pain associated with the enlargement.

What have your Doctors said about the lymph nodes? Have they physically palpitated them and given you a thorough exam?

I'm not saying that you have a malignancy because I don't know, however, if it were me I would want to know for sure that there is not one there and the only way to be sure is with a biopsy (fore go a needle biopsy because they are abysmal at detecting disease in lymph nodes - I found this out after the fact)

I have learned that you must be your own advocate for your health and push, push, push to get answers even if they are not the ones you want to hear. With cancer time is so critical. The sooner you can get treatment the more likely you are to survive long term.

I wish you the best of luck and be sure to report back your findings.

[Hydrophile]

Non painful lymph nodes are not usually a good sign. When you say your throat what area are you talking about?

I had a single enlarged lymph node in my clavicle area of my neck it. The CT showed it was about 3CM in size. It was non painful. After I was finally diagnosed and had staging done it was determined that my cancer had likely started in my chest near the heart and progressed to the neck. I had lesions on both sides of my neck but only the left side had noticeable enlargement.

For the biopsy, I had a CT guided needle biopsy performed and it came back negative. But I was getting very sick with flu like symptoms among other things. So a week later I went to a surgeon and had an excisional biopsy done which required a slice of the lymph node to be taken out and looked at by pathology. They place it under a high powered microscope and look for any problems. For me, they found nodular sclerosing cells (Hodgkin's Lymphoma)

I was just recently diagnosed with hashimotos and the antibodies were not extremely elevated so it's probably not been going on for a very long time.

Through my research and talking to doctors who specialize in this area. Lymphodenapathy can be caused by infection and some other disease processes but often time there is pain associated with the enlargement.

What have your Doctors said about the lymph nodes? Have they physically palpitated them and given you a thorough exam?

I'm not saying that you have a malignancy because I don't know, however, if it were me I would want to know for sure that there is not one there and the only way to be sure is with a biopsy (fore go a needle biopsy because they are abysmal at detecting disease in lymph nodes - I found this out after the fact)

I have learned that you must be your own advocate for your health and push, push, push to get answers even if they are not the ones you want to hear. With cancer time is so critical. The sooner you can get treatment the more likely you are to survive long term.

I wish you the best of luck and be sure to report back your findings.

I don't have lesions or painful nodes. Doctor ran an ultrasound on them and it came back negative.

My throat it sometimes feels swollen, but is not visible swollen. I'm assuming that's from hashimotos and the groin nodes are just immune system getting irritated.

My GP said he would be concerned if there were more than one in the groin, then the next week I noticed 3 more.

[CSI007]

Painful nodes usually mean infection or reactive lymph nodes. You are saying they are non painful. A lesion is a term used to describe a "non-normal" tissue that may or may not be a malignancy.

Ultrasound it worthless for diagnosing the cause of lymphodenapathy.

I'm curious, where are you getting health care? Are you in the states?

[Lee_1978]

My estrodial is 12 pg/ml. Didn't think that was high but I haven't looked into it.

Men can still suffer from thyroid issues (I'm evidence of that) but there are other factors that come into play. Speak to your GP about this.