Forty-Three Years Old, Low T Symptoms

Hello all.

My name is Jason. I'm 43 years old and married with 2 outstanding children. I have suffered from lethargy/fatigue for a long time, along with many other symptoms of low T. I got blood work (twice) four years ago and my total T was 270 and 460. My old doctor offered to put me on a gel, but I declined at the time hoping to increase levels naturally. I also did a sleep study finding out I have sleep apnea. I use a cpap every night and get good sleep from it, but my quality of life and symptoms didn't noticeably improve.

The severity of my symptoms has been progressively increasing, so I decided to see my doctor to get check out. He order a new auto regulating cpap for me and blood tests. My follow up with the doctor is next Friday. I'm hoping get my life back and have more positive energy for my family. I will post my lab results soon.

We're glad you joined Excelmale and hope your efforts to turn things around succeed.

Thank you CoastWatcher.

These are my initial labs.

[FONT=&quot]Description Result Reference Range[/FONT][FONT=&quot] [/FONT]
[FONT=&quot]5/31/2017[/FONT]
[FONT=&quot]Abs Baso Ct[/FONT][FONT=&quot] 0.02 K/mcL 0.00 - 0.20[/FONT]
[FONT=&quot]Abs Eos[/FONT][FONT=&quot] 0.18 K/mcL 0.00 - 0.45[/FONT]
[FONT=&quot]Abs Immature Gran Ct[/FONT][FONT=&quot] 0.01 K/mcL 0.00 - 0.06[/FONT]
[FONT=&quot]Abs Lymph Ct[/FONT][FONT=&quot] 2.78 K/mcL 1.00 - 4.80[/FONT]
[FONT=&quot]Abs Mono Ct[/FONT][FONT=&quot] 0.66 K/mcL 0.00 - 1.00[/FONT]
[FONT=&quot]Abs Neut Ct[/FONT][FONT=&quot] 4.07 K/mcL 1.70 - 7.80[/FONT]
[FONT=&quot]Basophils[/FONT][FONT=&quot] 0 % [/FONT]
[FONT=&quot]Eosinophil[/FONT][FONT=&quot] 2 % [/FONT]
[FONT=&quot]Immature Gran 0.1 % [/FONT]
[FONT=&quot]Lymphocytes - Normal[/FONT][FONT=&quot] 36 % [/FONT]
[FONT=&quot]Mature Neutrophils[/FONT][FONT=&quot] 53 % [/FONT]
[FONT=&quot]Monocyte[/FONT][FONT=&quot] 8 % [/FONT]
[FONT=&quot]Free T4[/FONT][FONT=&quot] [/FONT][FONT=&quot]0.7 ng/dL 0.6 - 1.6[/FONT]
[FONT=&quot]TSH[/FONT][FONT=&quot] [/FONT][FONT=&quot]3.63 mcIU/mL 0.30 - 5.00[/FONT]
[FONT=&quot]% Sat[/FONT][FONT=&quot] 11.7 % 20.0 - 55.0[/FONT]
[FONT=&quot]Iron[/FONT][FONT=&quot] 59 mcg/dL 62 - 196[/FONT]
[FONT=&quot]Transferrin[/FONT][FONT=&quot] 361 mg/dL 189 - 335[/FONT]
[FONT=&quot]HCT[/FONT][FONT=&quot] 47.2 % 38.5 - 53.0[/FONT]
[FONT=&quot]HGB[/FONT][FONT=&quot] 15.4 gm/dL 13.0 - 17.3[/FONT]
[FONT=&quot]MCH[/FONT][FONT=&quot] 30.5 pg 27.0 - 33.0[/FONT]
[FONT=&quot]MCHC[/FONT][FONT=&quot] 32.6 gm/dL 31.0 - 35.0[/FONT]
[FONT=&quot]MCV[/FONT][FONT=&quot] 94 fL 83 - 99[/FONT]
[FONT=&quot]MPV[/FONT][FONT=&quot] 9.7 fL 9.0 - 12.6[/FONT]
[FONT=&quot]Platelet[/FONT][FONT=&quot] 322 K/mcL 140 - 400[/FONT]
[FONT=&quot]RBC[/FONT][FONT=&quot] 5.05 M/mcL 4.30 - 5.90[/FONT]
[FONT=&quot]RDW-CV[/FONT][FONT=&quot] 13.9 % 11.0 - 18.5[/FONT]
[FONT=&quot]RDW-SD[/FONT][FONT=&quot] 47.2 fL 37.0 - 53.1[/FONT]
[FONT=&quot]WBC[/FONT][FONT=&quot] 7.7 K/mcL 4.0 - 11.0[/FONT]

[FONT=&quot]Albumin Lvl[/FONT][FONT=&quot] 4.4 gm/dL 3.5 - 5.7[/FONT]
[FONT=&quot]Alk Phos[/FONT][FONT=&quot] 48 IU/L 34 - 104[/FONT]
[FONT=&quot]ALT[/FONT][FONT=&quot] 25 IU/L 7 - 52[/FONT]
[FONT=&quot]Anion Gap[/FONT][FONT=&quot] 8 mmol/L 3 - 11[/FONT]
[FONT=&quot]AST[/FONT][FONT=&quot] 29 IU/L 13 - 39[/FONT]
[FONT=&quot]BUN[/FONT][FONT=&quot] 21 mg/dL 7 - 25[/FONT]
[FONT=&quot]Calcium[/FONT][FONT=&quot] 9.5 mg/dL 8.6 - 10.3[/FONT]
[FONT=&quot]Chloride[/FONT][FONT=&quot] 104 mmol/L 98 - 107[/FONT]
[FONT=&quot]CO2[/FONT][FONT=&quot] 27 mmol/L 21 - 31[/FONT]
[FONT=&quot]Creatinine[/FONT][FONT=&quot] 1.09 mg/dL 0.70 - 1.30[/FONT]
[FONT=&quot]Glucose Random[/FONT][FONT=&quot] 91 mg/dL 70 - 139[/FONT]
[FONT=&quot]Potassium[/FONT][FONT=&quot] 4.3 mmol/L 3.5 - 5.3[/FONT]
[FONT=&quot]Sodium[/FONT][FONT=&quot] 139 mmol/L 136 - 145[/FONT]
[FONT=&quot]Total Bilirubin[/FONT][FONT=&quot] 0.4 mg/dL 0.3 - 1.0[/FONT]
[FONT=&quot]Total Protein[/FONT][FONT=&quot] 7.2 gm/dL 6.4 - 8.9[/FONT]
[FONT=&quot]Testoster Total[/FONT][FONT=&quot] 210 ng/dL 250-1100[/FONT]
[FONT=&quot]Testoster Free[/FONT][FONT=&quot] [/FONT][FONT=&quot]79.5 pg/mL 46.0-224.0[/FONT]
[FONT=&quot]Folate[/FONT][FONT=&quot] >24.8 ng/mL >=5.9[/FONT]
[FONT=&quot]Vitamin B12[/FONT][FONT=&quot] 368 pg/mL [/FONT][FONT=&quot][/FONT]

You definitely have low testosterone, you may want more thorough testing. Here's a good thread.
https://www.excelmale.com/forum/sho...-After-Initiation-of-Testosterone-Replacement

1oldsoul said:

These are my initial labs.

Description Result Reference Range
5/31/2017
Abs Baso Ct 0.02 K/mcL 0.00 - 0.20
Abs Eos 0.18 K/mcL 0.00 - 0.45
Abs Immature Gran Ct 0.01 K/mcL 0.00 - 0.06
Abs Lymph Ct 2.78 K/mcL 1.00 - 4.80
Abs Mono Ct 0.66 K/mcL 0.00 - 1.00
Abs Neut Ct 4.07 K/mcL 1.70 - 7.80
Basophils 0 %
Eosinophil 2 %
Immature Gran 0.1 %
Lymphocytes - Normal 36 %
Mature Neutrophils 53 %
Monocyte 8 %
Free T40.7 ng/dL 0.6 - 1.6
TSH3.63 mcIU/mL 0.30 - 5.00
% Sat 11.7 % 20.0 - 55.0
Iron 59 mcg/dL 62 - 196
Transferrin 361 mg/dL 189 - 335
HCT 47.2 % 38.5 - 53.0
HGB 15.4 gm/dL 13.0 - 17.3
MCH 30.5 pg 27.0 - 33.0
MCHC 32.6 gm/dL 31.0 - 35.0
MCV 94 fL 83 - 99
MPV 9.7 fL 9.0 - 12.6
Platelet 322 K/mcL 140 - 400
RBC 5.05 M/mcL 4.30 - 5.90
RDW-CV 13.9 % 11.0 - 18.5
RDW-SD 47.2 fL 37.0 - 53.1
WBC 7.7 K/mcL 4.0 - 11.0

Albumin Lvl 4.4 gm/dL 3.5 - 5.7
Alk Phos 48 IU/L 34 - 104
ALT 25 IU/L 7 - 52
Anion Gap 8 mmol/L 3 - 11
AST 29 IU/L 13 - 39
BUN 21 mg/dL 7 - 25
Calcium 9.5 mg/dL 8.6 - 10.3
Chloride 104 mmol/L 98 - 107
CO2 27 mmol/L 21 - 31
Creatinine 1.09 mg/dL 0.70 - 1.30
Glucose Random 91 mg/dL 70 - 139
Potassium 4.3 mmol/L 3.5 - 5.3
Sodium 139 mmol/L 136 - 145
Total Bilirubin 0.4 mg/dL 0.3 - 1.0
Total Protein 7.2 gm/dL 6.4 - 8.9
Testoster Total 210 ng/dL 250-1100
Testoster Free79.5 pg/mL 46.0-224.0
Folate >24.8 ng/mL >=5.9
Vitamin B12 368 pg/mL

Click to expand...

You are clearly hypogonadal. That said, there are critical labs not listed here that are essential - LH, FSH, SHBG, DHT, DHEA, Estradiol/sensitive, T3, rT3, Prolactin, PSA. Are these in process?

I was also wondering are you on any type of meds that's lowering your testosterone. Like SSRI.

I'm on no meds, just a multi-vitamin, vit D, krill oil and curcumin.

My follow up with the doctor isn't until this coming Friday, so I'll find out what his next steps are. I just switched to this doctor out of a recommendation from my chiropractor, but I don't know what kind of experience he has with low T, etc. Hopefully I can build a good rapport with him and be able to openly discuss everything. I'll be sure to discuss the critical labs suggested above. Thanks for the advice/guidance.

Well...had a follow-up with my primary Dr. He felt it necessary to refer me to the local Endo in York, PA because he doesn't want to start me on TRT and possibly do more harm. So the endocrinologist's office (only one located in my area) called to schedule an appointment, but the earliest they have available is Sept. 28. Needless to say, I'm quite frustrated at this point.

I may consult with an independent TRT specialist like one of the board sponsors or possibly Telthera since they are close in Baltimore, Md as long as out of pocket expense is within my budget.

BTW, my primary doctor prescribed an iron supplement due to my low iron and % saturation. He also seemed baffled that my TT was low, but my FreeT was normal along with my TSH being 3.63 when previous tests over the years always had it in the low/mid 2's. I'm sure the picture will be clearer once I get more thorough testing.

Call Prime Body, Defy, and Telthera and get the full story of how much each practice would charge to treat you. With no appointment available until (essentially) the first of October, it may well be US Thanksgiving before you have a protocol in place (I live in Canada and we celebrate Thanksgiving much earlier).

I am scheduled to have a consult with Dr. Calkins from Defy on July 17. Below are the results of the blood tests they ordered for me. Cholesterol is pretty bad, but I've had levels like these ever since I started having symptoms of lethargy, brain fog, etc. The other item that was out of range was my SHBG. Hopefully Defy can get me back on my feet.

Ordered Items
Lipid Panel w/ Chol/HDL Ratio; DHEA-Sulfate; Luteinizing Hormone(LH), S; Prostate-Specific Ag, Serum; Estradiol, Sensitive; SexHorm Binding Glob, Serum; Venipuncture; Cardiovascular Report

Lipid Panel w/ Chol/HDL Ratio

Cholesterol, Total 365 High mg/dL 100 - 199 01
Triglycerides 213 High mg/dL 0 - 149 01
HDL Cholesterol 21 Low mg/dL >39 01
VLDL Cholesterol Cal 43 High mg/dL 5 - 40
LDL Cholesterol Calc 301 High mg/dL 0 - 99
T. Chol/HDL Ratio 17.4 High ratio units 0.0 - 5.0

DHEA-Sulfate 273.9 ug/dL 102.6 - 416.3 01

Luteinizing Hormone(LH), S
LH 3.9 mIU/mL 1.7 - 8.6 01

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.5 ng/mL 0.0 - 4.0 01

Estradiol, Sensitive 19.8 pg/mL 8.0 - 35.0 02

Sex Horm Binding Glob, Serum 6.1 Low nmol/L 16.5 - 55.9 01

1oldsoul said:

I am scheduled to have a consult with Dr. Calkins from Defy on July 17. Below are the results of the blood tests they ordered for me. Cholesterol is pretty bad, but I've had levels like these ever since I started having symptoms of lethargy, brain fog, etc. The other item that was out of range was my SHBG. Hopefully Defy can get me back on my feet.

Ordered Items
Lipid Panel w/ Chol/HDL Ratio; DHEA-Sulfate; Luteinizing Hormone(LH), S; Prostate-Specific Ag, Serum; Estradiol, Sensitive; SexHorm Binding Glob, Serum; Venipuncture; Cardiovascular Report

Lipid Panel w/ Chol/HDL Ratio

Cholesterol, Total 365 High mg/dL 100 - 199 01
Triglycerides 213 High mg/dL 0 - 149 01
HDL Cholesterol 21 Low mg/dL >39 01
VLDL Cholesterol Cal 43 High mg/dL 5 - 40
LDL Cholesterol Calc 301 High mg/dL 0 - 99
T. Chol/HDL Ratio 17.4 High ratio units 0.0 - 5.0

DHEA-Sulfate 273.9 ug/dL 102.6 - 416.3 01

Luteinizing Hormone(LH), S
LH 3.9 mIU/mL 1.7 - 8.6 01

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.5 ng/mL 0.0 - 4.0 01

Estradiol, Sensitive 19.8 pg/mL 8.0 - 35.0 02

Sex Horm Binding Glob, Serum 6.1 Low nmol/L 16.5 - 55.9 01

Click to expand...

Low SHBG is an issue that I'm sure Dr. Calkins will factor in as the two of you design your protocol. Typically, those of us with lower SHBG deal with it by injecting smaller amounts of testosterone on a more frequent basis.

What at is your diet like? Your glucose was reasonable, wasn't it?

CoastWatcher said:

Low SHBG is an issue that I'm sure Dr. Calkins will factor in as the two of you design your protocol. Typically, those of us with lower SHBG deal with it by injecting smaller amounts of testosterone on a more frequent basis.

What at is your diet like? Your glucose was reasonable, wasn't it?

Click to expand...

Yes, glucose was reasonable. My diet is high on protein. Carbs are in moderation. I've noticed the past few years that carbs tend to get me very bloated, so I try to limit them within reason. I probably eat more fat than the average person because of drinking whole milk, eating cottage cheese, etc. I never jumped on the no/low fat bandwagon.

I had an suspicion before these latest blood tests that SHBG might be low since my total T was below range, but my free T was within range on my initial labs. I didn't think it would be that low though.

Low SHBG is frustrating, but like CoastWatcher said there ways to mitigate the effects, smaller more frequent amounts is a common solution.

CoastWatcher, have you experimented with doing some injections subQ and others IM or do you do all either subQ or IM?

-Scott M
Telthera

CoastWatcher said:

Low SHBG is an issue that I'm sure Dr. Calkins will factor in as the two of you design your protocol. Typically, those of us with lower SHBG deal with it by injecting smaller amounts of testosterone on a more frequent basis.

What at is your diet like? Your glucose was reasonable, wasn't it?

Click to expand...

ScottM said:

Low SHBG is frustrating, but like CoastWatcher said there ways to mitigate the effects, smaller more frequent amounts is a common solution.

CoastWatcher, have you experimented with doing some injections subQ and others IM or do you do all either subQ or IM?

-Scott M
Telthera

Click to expand...

I hope it's not too frustrating Scott. I've read so much about low SHBG these past weeks on this forum and the internet that it's information overload. This endeavor seems like such a balancing act between hormones.

ScottM said:

Low SHBG is frustrating, but like CoastWatcher said there ways to mitigate the effects, smaller more frequent amounts is a common solution.

CoastWatcher, have you experimented with doing some injections subQ and others IM or do you do all either subQ or IM?

-Scott M
Telthera

Click to expand...

Daily shallow IM injections have worked for me. Since I inj cut daily I rotate sites and some of the shits do work out to be SubQ.

1oldsoul said:

I hope it's not too frustrating Scott. I've read so much about low SHBG these past weeks on this forum and the internet that it's information overload. This endeavor seems like such a balancing act between hormones.

Click to expand...

Low SHBG is a factor, a very critical factor, that has to be considered when designing a TRT protocol. However, it is one that many of us have to take into consideration. Don't lose hope - you and a good doctor can do this.

I'd definitely want to have free T3 and free T4 pulled prior to my consult if that were me, hypothyroidism can definitely contribute to low SHBG.

Also, proper thyroid treatment can raise SHBG pretty significantly.

Another possible contributor to your low SHBG would be metabolic syndrome, which low testosterone can contribute to as well due to lowered insulin resistance which lowers SHBG and it becomes this giant self fulfilling prophecy.

So an A1C test probably isn't a bad idea.

I've thought about having a more thorough thyroid panel completed. My family doctor tested my thyroid 9 and 4 years ago. Both times it was in the low to mid 2 range for TSH, but it is now 3.6. T3 and T4 were never tested.

The metabolic syndrome/insulin resistance crossed my mind also because of my lipid panel results and the low SHBG. Was wondering if metformin would be a possibility along with TRT. Again, so many things to balance consider. I want to stay patient though, and start with the TRT to see how that affects everything. Then possibly move onto the thyroid and insulin issues. I'm sure the doctor will properly guide me. I just don't want to throw too many variables into the mix and not be able to clearly see what is helping or hindering symptoms.