Struggling with low T for years, finally going to fix it

[thewolf49]

Long story short, I've been struggling with low T for years. I've tested as low as 134 and as high as 450 (highest I've ever tested - at 21 years old). Basically, every blood test I've ever gotten shows the following: low total T, low free T, low/normal LH, low/normal FSH. Thyroid, E2, SHGB, everything else always comes back normal. Here's my latest bloodwork (below). My question is, what can I do to raise my LH and FSH levels? Herbs, gnrH shots (to stimulate the pituitary to create LH and FSH), etc? I'd like to avoid a lifetime of TRT if possible.

I'm 27 years old, 215lbs (I tested at 134 when I was 165lbs and in shape)

Testosterone, Free & Total LC/MS/MS:
FREE TESTOSTERONE 42.5 Range: 35.0-155.0 pg/mL (Collection Date: 12/23/2015)
TESTOSTERONE, TOTAL, LC/MS/MS 274 Range: 250-1100 ng/dL (Collection Date: 12/23/2015)

FSH:
Follicle Stimulating Hormone 1.8 (no range given)

LH:
Luteinizing Hormone 1.7 (no range given)

Cortisol 10.80 (no range given)

Free T4 1.0 Range: 0.7-1.8 ng/dL (Collection Date: 12/23/2015)

Free T3 276 Range: 200-490

TSI (Thyroid Stimulating Immunoglobulin):
TSI <89 Range: <140 % baseline (Collection Date: 12/23/2015)

THYROID PEROXIDASE ANTIBODIES 1 Range: <9 IU/mL (Collection Date: 12/23/2015)

ESTRADIOL 26 Range: < OR = 39 pg/mL (Collection Date: 12/23/2015)

Prolactin 1.7 Range: 3.3-20.8 ng/mL (Collection Date: 12/23/2015)

TSH 1.81 Range: 0.50-6.00 MIU/mL (Collection Date: 12/23/2015)

FOLATE, SERUM 17.6 Range: ng/mL (Collection Date: 12/23/2015)
VITAMIN B12 668 Range: 200-1100 pg/mL (Collection Date: 12/23/2015)

Vit D 25 OH (Total) 61.5 Range: 31.0-100.0 ng/ml (Collection Date: 12/23/2015)

 

[thewolf49]

KSman over at TNation mentioned I have low thyroid function based on the labs above...is he talking about the free T3 number? Also said cortisol is near bottom of acceptable

 

[Mr.TT]

Do or have you used:
AAS ?
OPIATES ?
Alcohol use ?
or Head Injury ?
Soy or Ginseng ?
What's Your DIET like ?
How much stress do you have?
Sleeping well?

DHEAs blood test would be helpful.

Your lab numbers look like secondary hypogonadism.

 

[thewolf49]

AAS - no. Lots of stimulants and a couple mild 'pro hormones'/AI's. That was a while ago. No opiates. I drink yes but just on weekends and not too much. No head injury. No soy or ginseng. Diet currently is about 1800 cals, 220P, 75F, 80C - ish. Not a lot of stress (cortisol was low side if anything).

I am most definitely secondary, I just haven't been able to figure out why for 7 or 8 years when this all started. It could have been my whole life for all I know. I had an MRI roughly 7 years ago and all was fine. I think I'm going to have my doc test for:

Progesterone
DHEAs
DHT

and go from there. Is it possible I have low T 'just because'??

 

[kenpoengineer]

Any statins? How's your cholesterol panel? Your 1800 cal diet is low. What weight and height? Hormones are made using cholesterol as the building block. With your fat macro so low maybe your cholesterol levels are low as well. This chart shows the hormone system:

 

[thewolf49]

My cholesterol levels are all in range, I just had them tested for work a couple months ago. I'm trying to drop some weight. 75 grams of fat per day is low?

Keep in mind, I tested for low T when I was a gym rat, perfect diet, weighed 170lbs, lifting all the time in college, so I have anything but ruled out my weight. My problem seems to be that my pituitary doesn't product enough LH and FSH, and maybe never has. I've never tested over about 2.5 on either one. I am also estrogen dominant. Thyroid function seems a little low as well, but I doubt if it was 100 points better my testosterone would suddenly rise by 500 points......

Think I will get progesterone, DHEA, and DHT tested. Anything else I should be looking at besides what I posted and those 3 I just mentioned? Is it possible it's just hereditary?

 

[Mr.TT]

Is it possible I have low T 'just because'??

Yes, it seems so.

I would have Preg, DHEAs, checked.
Then maybe try CLOMID (low dosages) to see how much you LH you can stimulate.
Depending on the CLOMID results, then consider hCG( low dosage amounts).

 

[thewolf49]

Yes, it seems so.

I would have Preg, DHEAs, checked.
Then maybe try CLOMID (low dosages) to see how much you LH you can stimulate.
Depending on the CLOMID results, then consider hCG( low dosage amounts).

So, only if Clomid stimulates LH, I then would try HCG mono-therapy? What about FSH?

 

[Mr.TT]

Those Pro-hormones are a big question mark, who knows what affect they may have.

I would try low dose CLOMID first, to see if your HPTA will make LH and FSH.
If CLOMID increases LH, then we see how much your TT increases. (and your E2 and SHBG)

If CLOMID does NOT work, I would try low dose hCG to see how your gonads respond.
hCG is a can of worms, because it also mimics TSH, and stimulating your thyroid, just adds another variable.
Your trying to increase TT and consequently raise FT, without boosting E2.

TRT is a last resort, especially at your age.
SARMs, may someday, will be the answer for a lot of us.

Have you ever used DHT blockers?( anti-hairloss meds)
What was your SHBG and range?

 

[thewolf49]

Those Pro-hormones are a big question mark, who knows what affect they may have.

I would try low dose CLOMID first, to see if your HPTA will make LH and FSH.
If CLOMID increases LH, then we see how much your TT increases. (and your E2 and SHBG)

If CLOMID does NOT work, I would try low dose hCG to see how your gonads respond.
hCG is a can of worms, because it also mimics TSH, and stimulating your thyroid, just adds another variable.
Your trying to increase TT and consequently raise FT, without boosting E2.

TRT is a last resort, especially at your age.
SARMs, may someday, will be the answer for a lot of us.

Never used DHT blocks. SHGB 18 Range: 10-50 nmol/L

Have you ever used DHT blockers?( anti-hairloss meds)
What was your SHBG and range?

Thanks for the reply. With my low LH and FSH, I am concerned about fertility, so I think I'm going to go to my urologist and get my sperm count tested. Want to have kids in a couple years. So, if he prescribes me Clomid, a rise in T may be a 'side effect'. After I have kids, if my testosterone doesn't hold after coming off Clomid, I can maybe think about TRT if things remain the same as they are now.

Or - he puts me on T and HCG, and then has me take Clomid when it's time to have kids. Who knows.

Never used DHT blockers. SHGB 18 on a 10-50 range.

Can you explain how HCG maintains fertility? Everything I've read says it replaces LH, but doesn't mention it's FSH effect or how it increases sperm count. FSH is for sperm, if HCG only acts as LH, how does it maintain fertility on TRT?

 

[Mr.TT]

https://en.wikipedia.org/wiki/Human_chorionic_gonadotropin

hCG mimics three hormones. LH, FSH, and TSH.

 

[thewolf49]

https://en.wikipedia.org/wiki/Human_chorionic_gonadotropin

hCG mimics three hormones. LH, FSH, and TSH.

Understood. I think I am going to try this:

1. 4-6 weeks of 250iu of HCG EOD, retest TT, FT, E2. If testosterone levels are not up, stop and do TRT. If they are up, stop HCG and do 4-6 weeks of 20mg Nolvadex.
2. Retest TT, FT, E2, LH, FSH. If LH and FSH numbers are up and testosterone is up, stop all drugs and see if the results 'stick' - retest bloods in 6-8 weeks after stopping everything. If right after the Nolva LH and FSH are up and testosterone is not, stop and do TRT. If right after the Nolva LH and FSH numbers are not up, stop and do TRT.

This is the restart protocol on another popular forum (not sure if I can name names).

Other questions:

My thyroid function looks low in the labs above, especially free T3, can anyone confirm? Would getting this number up increase my LH and FSH?

 

[Mr.TT]

50 lbs of body fat may be affecting your thyroid numbers.
Are you getting good intake levels of selenium and iodine?
I'm hypothyroid and on 2 3/4 grains of desiccated thyroid, my TT3, FT3, TT4, FT4, and TSH are all
at the bottom of their ranges. I still make TT above 700.

I would have started with a SERM(CLOMID or NOLVA) to see if I could get an HPTA restart, and how much LH. I would start with a lower dose and blood test. (why take more than you need)

If a SERM did not increase my LH, then Pinning hCG would prove if my Testes work.

If SERM and hCG fail, (and my Preg and DHEAs levels are OK) Then TRT. (plus hCG for fertility)

One more weird thought.... Low SHBG can cause HPTA to maintain Low TT. There have been
posters on this site who had very low SHBG levels and were desperate to find a way to increase it.
They believed that their low SHBG was causing their testosterone problems. I don't know if they
are correct. But, if your thyroid numbers (TT3 and FT3) are low, you could use LOW, (spread out
over the day) T3(liothyronine) doses. It can annoy your liver and increase SHBG. (just a thought)


r

 

[The Matrix]

low thyroid numbers
B-12 sucks and is low
Prolactin is low
Lh is low
Cortisol are too low
Vitamin D 25 is worthless with out 1,25
No SHBG
No CBC
No CMP
No RBC minerals

Probably something impacting HPTA but need to find out what and why ..

Please provide
History
Current Symptoms
Lifestyles
State you live in - environmental factors
What has occurred with in 6 months prior to symptoms

 

[OGscientist]

Hi,
Luteinizing Hormone (LH) is a "Superhormone" produced by the pituitary gland and responsible for the synthesis of several lower level hormones such as FSH, TSH and testosterone. You can read the complete and complex chemistry here and in Wikipedia.

In males, human chorionic gonadotropin (hCG) binds to cells in a similar fashion as does LH. Thus, it is used to indirectly replace (or supplement) free and total testosterone levels in males.

Most physicians are not well versed in hormone replacement therapy, although awareness is increasing as the population--including them--ages.

Low LH levels are the most common reason for male hypogonadism. Assuming no testicular damage, one should start with hCG if LH levels and free testosterone levels are low. However, at your low t levels, very unpleasant emotional disturbances can occur, so you might want to start with a combination of the two hormones.

After 6-8 weeks, lab tests can indicate a decrease of external testosterone and an increase in hCG.

It's always a good thing to produce hormones containing your own DNA. This is why secretagogues like Sermorelin Acetate are prefereable to external hGH sources.

The amount of hormone produced by secretagogues are limited by the gland itself, so a hormone overdosage is virtually impossible. If wanting to produce levels beyond the glandular abilities of human beings...then the choices are different.

For example, I started replacement therapy, with similar T and LH levels, using weekly injections of 100mg of testosterone cypionate and 100 IUs of hCG. After 8 weeks my free and total testosterone levels increased to 28 and 1300. Now, I maintain similar numbers with only 50 mg TC and 210 IUs of hCG:

(50 cc TC intramuscular weekly)
(30 cc hCG subcutaneous daily)

One nice hCG benefit is lack of testicular atrophy.

I'd steer clear of the gels--unless you never sweat, have an endless clothes budget and no folks or pets in the house. And you like daily roller coasters.

So, I'd first start with the testosterone replacement therapy and see how your other numbers look after these resolve. But do try to find a physician who'll prescribe both hormones.

Keep us posted.

 

[OGscientist]

Oops, my corrected *free* testosterone levels are 180, not 28--where I started. My bad.

 

[thewolf49]

low thyroid numbers
B-12 sucks and is low
Prolactin is low
Lh is low
Cortisol are too low
Vitamin D 25 is worthless with out 1,25
No SHBG
No CBC
No CMP
No RBC minerals

Probably something impacting HPTA but need to find out what and why ..

Please provide
History
Current Symptoms
Lifestyles
State you live in - environmental factors
What has occurred with in 6 months prior to symptoms

CBC and CMP:
CBC:
WBC 6.3 Range: 3.8-10.6 K CUMM (Collection Date: 12/23/2015)
RBC 5.71 Range: 4.20-5.80 M CUMM (Collection Date: 12/23/2015)
HGB 16.3 Range: 13.5-18.0 g/dL (Collection Date: 12/23/2015)
HCT 49.3 Range: 42.0-52.0 % (Collection Date: 12/23/2015)
PLT 113 Range: 130-400 K CUMM (Collection Date: 12/23/2015)
BASO # 0.1 Range: 0.0-0.2 K CUMM (Collection Date: 12/23/2015)
BASO % 1.0 Range: 0.0-3.0 % (Collection Date: 12/23/2015)
EOS # 0.2 Range: 0.0-0.4 K CUMM (Collection Date: 12/23/2015)
EOS % 2.5 Range: 0.0-7.0 % (Collection Date: 12/23/2015)
LYMPH # 1.7 Range: 0.7-4.5 K CUMM (Collection Date: 12/23/2015)
LYMPH % 27.4 Range: 14.0-46.0 % (Collection Date: 12/23/2015)
MCH 28.6 Range: 27.0-31.0 pg (Collection Date: 12/23/2015)
MCHC 33.1 Range: 32.0-36.0 g/dL (Collection Date: 12/23/2015)
MCV 86.3 Range: 78.0-100.0 fL (Collection Date: 12/23/2015)
MONO # 0.5 Range: 0.1-1.0 K CUMM (Collection Date: 12/23/2015)
MONO % 7.6 Range: 4.0-13.0 % (Collection Date: 12/23/2015)
MPV 10.1 Range: 7.4-10.4 fL (Collection Date: 12/23/2015)
NEU # 3.9 Range: 1.8-7.8 K CUMM (Collection Date: 12/23/2015)
NEU % 61.5 Range: 40.0-74.0 % (Collection Date: 12/23/2015)
RDW 13.1 Range: 11.5-15.5 % (Collection Date: 12/23/2015)

CMP:
Albumin 4.8 Range: 3.5-5.0 g/dL (Collection Date: 12/23/2015)
Alk Phos 81 Range: 23-159 U/L (Collection Date: 12/23/2015)
ALT 19 Range: 21-72 U/L (Collection Date: 12/23/2015)
AST 24 Range: 17-59 U/L (Collection Date: 12/23/2015)
BUN 17 Range: 8-24 mg/dL (Collection Date: 12/23/2015)
Calcium 9.9 Range: 8.5-10.5 mg/dL (Collection Date: 12/23/2015)
Chloride 101 Range: 98-107 mmol/L (Collection Date: 12/23/2015)
CO2 27.0 Range: 22.0-30.0 mmol/L (Collection Date: 12/23/2015)
Creatinine 0.9 Range: 0.3-1.4 mg/dL (Collection Date: 12/23/2015)
GFR 101 Range: >60 mL/min per 1.73 (Collection Date: 12/23/2015)
Glucose 92 Range: 74-100 mg/dL (Collection Date: 12/23/2015)
Potassium 4.7 Range: 3.5-5.3 mmol/L (Collection Date: 12/23/2015)
Sodium 142 Range: 134-144 mmol/L (Collection Date: 12/23/2015)
T. Protein 7.8 Range: 6.3-8.4 g/dL (Collection Date: 12/23/2015)
Total Bili 0.8 Range: 0.2-1.3 mg/dL (Collection Date: 12/23/2015)

Urinalysis:
Bilirubin negative Range: negative (Collection Date: 12/23/2015)
Blood negative Range: negative (Collection Date: 12/23/2015)
Clarity Clear Range: clear (Collection Date: 12/23/2015)
Color straw Range: yellow (Collection Date: 12/23/2015)
Glucose negative Range: negative (Collection Date: 12/23/2015)
Ketones negative Range: negative (Collection Date: 12/23/2015)
Leukocytes Negative Range: negative (Collection Date: 12/23/2015)
Nitrite negative Range: negative (Collection Date: 12/23/2015)
pH 7.0 Range: 5.0-9.0 (Collection Date: 12/23/2015)
Protein negative Range: negative (Collection Date: 12/23/2015)
S.G. 1.016 Range: 1.001-1.035 (Collection Date: 12/23/2015)
Urobilinogen Negative Range: negative (Collection Date: 12/23/2015)


I will ask about the B12, prolactin, and cortisol numbers.
Why is the Vit D test worthless?
SHBG is always toward the bottom of the range so I didn't get it checked this time

 

[The Matrix]

Dr did not mention low platelets?
Vitamin D 25 OH is useless with out 1,25
Ft3 is low normal
SHBG being low may be insulin resistance or low thyroid function.
4 point cortisol saliva would be highly recommended

 

[thewolf49]

Alright guys - met with the new doc that my primary care doc referred me to and we're going to try Clomid at 25mg/day to see if it helps my LH and FSH, therefore testosterone. She mentioned low platelets, and is testing them again, along with some pituitary tests, cortisol (am), ft3, ft4, the whole she-bang again. She seems willing to listen and work with me. Mentioned she has a lot of guys on Clomid and the success rate is very good. We'll see how it goes.

What could be causing the low platelets? I'll post the blood work from this doc as soon as the results are in.

Question - what percentage of total T should be free T be? Also, what is a good testosterone to estradiol ratio?

 

[OGscientist]

Good luck with the Clomid--didn't work for me. HGC works great. But I still need to supplement with some testosterone, although only half of what I need without HCG. Also, take Anastrozole 25mg tablets twice a week to inhibit any conversion to Estrodiol.

There are no ratio guidelines for total vs free testosterone; every human body is different. In my case, it's about 1 part free to 5 parts total. The free range from the lab gives you what you're aiming to get.

The same is true for Estrodiol and Testosterone. Everyone is different. But if you compare lab ranges you can get a general sense.

No offense friend, but you seem to be over thinking this process. LOL, this from an astrophysicist who regularly thinks too much! Just use the scientific method--make as few changes as possible and observe the results. When, or if, the Clomid increases your free Testosterone levels--other values will change.

Some folks just have lower serum platelet levels than others. Have you compared to previous platelet levels? Are these the first labs you've ever submitted?

I encourage everyone to get and save a copy of every lab results taken. Also remember labs can give incorrect results (ie false negatives or false positives).

Finally, consider the circumstances when labs are taken. For example, when my LH levels tanked, my cholesterol levels increased. This was do to the feedback loop in the brain's glands saying "we need more testosterone to be happy, so allow more cholesterol from which it's made." This is an oversimplification but my primary care physician freaked and wanted me on stations. My endocrinologist said, "let's first get your Testosterone levels under control and see if the cholesterol normalizes." It did.

Good luck with the Clomid. But if it doesn't work, daily subcutaneous injections of HCG are nothing. Using a 30 gauge 5/16 inch insulin needle is nothing; you can jab most anywhere and it doesn't hurt a bit.

Even the 25 gauge 1 inch testosterone injections are a piece of cake. Just move around both thighs, deltoids, etc. You'll learn anatomy quickly to avoid nerves and major veins and arteries. Always draw back first to check for blood. You must know what you're doing, but I've injected the biceps brachii from the side.

Anyway, your on the right track, but ignore some of these other numbers until you get your total and free testosterone levels into the normal range. Otherwise, you'll drive yourself crazy. Been there.

Eric

 

[thewolf49]

So, new bloodwork after a little over a month on 25mg ED of Clomid.

Total T, 682 (range 250-827)
Estradiol, 50 (range under 39) **
TSH, 1.54
Free T3, 3.2 (range 2.3-4.2)
FSH, 4.1 (range 1.6-8)
LH, 4.5 (range 1.5-9.3)

So, looks like my HPTA needed a kick in the pants. I have an appt. this week to discuss next steps. I'd like to try to get that Estradiol number down in the 20-30 range. It was 26 before Clomid.

Other than that, so far so good. She didn't test Free T even though I insisted on it multiple times....can't win them all :/

Thoughts?

 

[damage007]

So, new bloodwork after a little over a month on 25mg ED of Clomid.

Total T, 682 (range 250-827)
Estradiol, 50 (range under 39) **
TSH, 1.54
Free T3, 3.2 (range 2.3-4.2)
FSH, 4.1 (range 1.6-8)
LH, 4.5 (range 1.5-9.3)

So, looks like my HPTA needed a kick in the pants. I have an appt. this week to discuss next steps. I'd like to try to get that Estradiol number down in the 20-30 range. It was 26 before Clomid.

Other than that, so far so good. She didn't test Free T even though I insisted on it multiple times....can't win them all :/

Thoughts?

LH/FSH are commonly kicked back by negative feedback - not just Estradiol but also Prolactin , Cortisol etc...there are other factors that affect the efficiency of your hypothalamus and gonadotropin-gene-expression such as Melatonin (deficiency or excess is no good) and also second messengers such as cAMP which Forskolin increases...

 

[thewolf49]

LH/FSH are commonly kicked back by negative feedback - not just Estradiol but also Prolactin , Cortisol etc...there are other factors that affect the efficiency of your hypothalamus and gonadotropin-gene-expression such as Melatonin (deficiency or excess is no good) and also second messengers such as cAMP which Forskolin increases...

What are you saying? I've had all those things tested multiple times and they're fine.

 

[damage007]

What are you saying? I've had all those things tested multiple times and they're fine.

I doubt you've had melatonin tested..there is no standard test for it - you'd have to specifically ask for it by a neuro.
There are plenty of ways to augment your current regimen.

 

[thewolf49]

I doubt you've had melatonin tested..there is no standard test for it - you'd have to specifically ask for it by a neuro.
There are plenty of ways to augment your current regimen.

Have another appt. Wed. Hopefully can get arimidex to lower e2.

 

[Mr.TT]

So, new bloodwork after a little over a month on 25mg ED of Clomid.

Total T, 682 (range 250-827)
Estradiol, 50 (range under 39) **
TSH, 1.54
Free T3, 3.2 (range 2.3-4.2)
FSH, 4.1 (range 1.6-8)
LH, 4.5 (range 1.5-9.3)

Thoughts?

Congratulations, you do not need TRT. If you live in a FREE state, I would order(online) my own FT blood test.
After all, IMO, it is your FT to E2 ratio that's you are trying to improve. We would expect to see your E2 to jump if your
FT improved, and it did.

I prefer AROMASIN to Anastrozole.
There are people who use 1/4 of a 25mg of CLOMID EOD, and get great results ( 25mg a day could be overkill).

 

[thewolf49]

Congratulations, you do not need TRT. If you live in a FREE state, I would order(online) my own FT blood test.
After all, IMO, it is your FT to E2 ratio that's you are trying to improve. We would expect to see your E2 to jump if your
FT improved, and it did.

I prefer AROMASIN to Anastrozole.
There are people who use 1/4 of a 25mg of CLOMID EOD, and get great results ( 25mg a day could be overkill).

I will order the test and have it done.

Also, got my IGF-1 test back. 94 (range 63-373). Should I be concerned about this?