33 years old - Low T - What to do next??

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 low as:

1st set of bloodwork:

279 total Test (ng/dl) (Normal 300-1000).
TSH 1.0 (0.5 to 5.0)

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 Doctor did not approve. Here are those results.

2nd set of bloodwork:

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

Then I went to a Urologist.

3rd set of bloodwork follows:

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)

After a very disappointing appt with the urologist, he said that there was nothing else to test for. I knew this was not correct so I went out and got my own bloodwork done. In addition, he offered the options of possibly starting TRT or trying out Clomid. He prescribed Clomid 25 mg/day and told me to come back in three months. I'm currently on the fence about starting this clomid. So I went and got some private bloodwork done and my testosterone came back even lower!

4th set of bloodwork:

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

So basically I am at a loss right now of what to do. Should I start this Clomid? Are there other things I should test for or do before giving the Clomid a shot?

I actually sent out a 4/day saliva cortisol test Today. That will actually check for test, progesterone, E2 and DHEAS. I figured if anything I can get a saliva reading and a cortisol reading.

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!! It is truly appreciated. Sorry for the long post!

Welcome to Excelmale. The first thing you should consider if obtaining capable medical assistance. Like so many of us, you have stumbled into the world of TRT non-knowledge. If local care isn't available to help you, there is Defy Medical (I am not a patient) that serves the health of many of our members.

You clearly have a good sense of what to look for in terms of labwork. Low testosterone, low estradiol, low SHBG...not a pretty picture. Did I see thyroid testing and a psa? If not, those are important as well. It would be worth discussing a restart with a qualified doctor - you aren't yet 40. Is fertility an issue? Might it be?

The good news is that help is available.

Matteo: I was having difficulty myself finding an independent Dr. in my area who knows what they are doing with TRT. Give Defy medical a call. I did and I am on my way to getting proper and cutting edge TRT. At this point you are more informed about TRT than most of the Docs you have encountered.

Thanks guys! I certainly would love to hear the expertise from Defy Medical, but first I'd like to get some more bloodwork (preferably covered by insurance). I'm seeing another doctor tomorrow that was listed here on this forum and it seems he has some experience on hormones and TRT. Maybe he can test for T3 and T4? The receptionist actually mentioned it when I called, so it seems like they might have an idea. That way when if I do speak with Defy, at least I have more data to go off of. The last urologist didn't even want to test for anything other than total T, prolactin, LH and FSH.

Unfortunately, I already shelled out a good chunk of money on that last set of bloodwork and the saliva test. So I really need to be careful with what I spend right now.

I live in Austin, TX by the way so if anyone knows a good doctor here that accepts insurance I'd love a good recommendation.

I'm really wondering if I should just start the clomid that was recommended or if I should hold off for now. Is there any harm in starting it do you think?

Budget is always a factor so don't extend yourself of course. You do have current labs that Defy would accept so that would save you money. But you need to stay within your budget. I'm In a Houston, TX suburb, but we do have some good TRT Docs here. It's a long heavy traffic drive for me to go to the medical center, downtown etc. and such. I'm not sure about Austin. Check the forums for TRT and see if anything turns up.

Im not well versed on Clomid so I'll stay silent on it.

This is a thread started by Dr. Justin Saya, Defy's medical director, on Clomid.

https://www.excelmale.com/forum/sho...or-do-they-really-exist&highlight=clomid+saya

Matteo, You're on the high normal of FSH yet low end of LH. Isolated LH deficiency, if that's what you have, is uncommon. You'll want to repeat both tests with your next early am fasting T labs. I'm in favor of MD supervised restart. Improve your odds of lasting success. If Clomid is prescribed take it in concert with improved nutrition and reduced exposure to environmental toxins.

It's great that you are looking for answers before jumping on TRT. While waiting to connect with a qualified doc review endocrine disruptors. Remove them from your diet, your cleansers and household products and your environment as best you can. Insidious sources include fire retardants in household furnishings. Total elimination is impossible but we can reduce the load.

"The impact of antidepressant-induced sexual dysfunction is substantial and negatively affects quality of life, self-esteem, mood, and relationships with sexual partners."
Dr.Scully

A significant number of folks achieve at least some relief by boosting their intake of fresh food, certain aminos vitamins herbs and a few proven supplements in pure powders form. Don't waste money on the latest hype or store bought formulas. Refer to resources here as to what's worth trying.

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!!!

The wrong estradiol test was run. Men need to have estradiol tested via the sensitive assay (LC, MS/MS). You are likely to have very low estradiol levels as the standard test you ran overestimates E2 in men. Your thyroid picture is not quite complete; RT3 and antibodies should be captured as well. You can obtain them on your own via Discountedlabs.com. What did this doctor say regarding the possibility of a Clomid restart? Did he understand it is a bit more complex than TRT, and takes patience?

CoastWatcher said:

The wrong estradiol test was run. Men need to have estradiol tested via the sensitive assay (LC, MS/MS).

Click to expand...

I tested that on my own last time with discounted labs and the numbers are in my previous bloodwork.

Estradiol, Sensitive 11.3 pg/mL (8.0 - 35.0)

CoastWatcher said:

What did this doctor say regarding the possibility of a Clomid restart? Did he understand it is a bit more complex than TRT, and takes patience?

Click to expand...

This doctoer didn't really entertain the idea of the clomid restart. He says usually people come to him after it doesn't work and they go the route of TRT. Whereas, my last urologist wanted me to try 25 mg every day and then follow up in 3-4 months.

I feel pretty comfortable starting on the 12.5 mg every day and test again in a few week and see what kind of progress is being made.

I presume you have read the previously attached thread that Dr. Saya started. You understand how to monitor/test/manage side effects and, perhaps most importantly, that a Clomid protocol takes time to achieve its goals. (if it achieves them). All the best.