1. #1

    28 year old with 209 total test and other issues, seeking advice

    Hello everyone,

    First of all I want to say this is my first post and I greatly appreciate anyone here who is taking the time to read it along with any advice you're willing to share.

    Please bear with me as I explain my somewhat lengthy situation.. I'm sorry if I ramble a little but I'm not sure if these things can contribute to low T or if there might be a correlation. My energy levels are at an all-time low these days and so my quality of writing is somewhat lacking.

    I've had a lifelong history of mild depression, anxiety, emotional trouble, lack of confidence, low self esteem, low motivation, low sex drive, ED. Being born this way I never really thought much of it unfortunately. This led to a pot addiction when I was 20 that eventually just made things worse.

    I've had ups along with the downs but those periods are fewer and far between.

    Fast forward to now (actually 3 months ago) and I seem to be getting worse every week. I've had:

    • Unrelenting fatigue. I'm tired when I wake up and stay mentally/physically tired all day long.
    • NO motivation. It's a huge task to do even the smallest things unless it's absolutely necessary.
    • Bad sleep. It's been getting slightly better but not much. I usually wake up after 5-6 hours and since I'm too lazy to get up I'll roll getting 15 minute mini naps until my alarm goes off.
    • Depression. Much worse than I've ever had before. I'm extremely apathetic (nothing interests me), no inner monologue, suicidal ideation (I would never do anything).
    • Terrible brain fog, concentration, memory. I have lot of trouble lately just listening to people and thinking of my reply. I feel like a 90 year old man, honestly. Writing this post is extremely draining.
    • Irritability, which I try not to show.


    All these things I've had before in some sense but not this consistently, not to this extreme and not all at once. It's been seriously affecting my life.

    The only thing that has changed in 3 months that I can pin point is I've:
    • Stopped smoking marijuana due to having panic attacks.
    • Moved out of my room mates place because him and his girlfriend have gotten very serious.
    • Had to move back home to recoup/figure out if I want to move into an apartment or save up and get a house.
    • Last but not least I've been clearing my throat and finding grey phlegm every day, multiple times a day for 3 months. At first I thought it was my lungs clearing the tar from the weed but my GP I did a sputum culture and said that it tested positive for aspergillous. So I went to a pulmonologist 2 weeks ago because I thought it was my lungs but they did a CT of chest and said they're clear. We did a CT of my sinus and he says I have mild chronic sinusitis and a polyp. I'm waiting to get an appointment with a ENT and infectious diseases doctor next but I believe I have some kind of fungal infection that is also causing some fatigue.


    Anyway a couple months back I go to my GP. I got many routine blood tests done (including Vitamin D) and everything coming back normal. My doctor thinks I have depression and so refers me to a psychiatrist and was prescribed anti-depressants. I took them for 2 days and stopped because they made me feel worse.

    Unsatisfied, I started doing my own research and recently came across "symptoms of low testosterone" in men. Every symptom was a check for me. I asked my GP to have my testosterone levels checked. They came back and I'm apparently sitting at 209 total testosterone.

    Without a discussion they prescribed me testosterone cypionate 1ml intramuscular once every two weeks for 60 days.

    So here I am, a 28 year old male with what I would assume is very low testosterone. I'm left wondering, have I always had low T and didn't know it?

    I have an appointment with a very good endocrinologist but that's not for another 3 weeks. I'd like to know why a person of my age has such low T. I mean, obviously something isn't working correctly. Pituitary tumor? Naturally high cortisol?

    Honestly I'm anxious to start TRT just so I can have any mental/physical energy because right now I'm really starting to lose my mind psychologically due to the depression, irritability and lack of focus, energy.

    I'm just worried that if I do then when I go see the endocrinologist that my hormone levels will be skewed and I'll have to have them rechecked. Meaning I'll have to temporarily stop the TRT anyway. I want to beat this naturally if I can and not be on TRT forever.

    Here is my plan and tell me what you guys think: I'll get a "pre-TRT male hormone / wellness panel" before I start the TRT. Then start TRT. That way when I go see the endocrinologist he'll already have all my baseline levels to look at and we can have a discussion from the get-go.

    What do you guys think?

    I really want to get out of this terrible mindset. My work performance is suffering BIG time. I feel like my shitty attitude is effecting the people around me and I hate it.

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  3. #2
    You'll have to post the blood tests for us to speculate about their meaning, as your symptoms are those that could be from any number of things.

    Total test is only one part of the puzzle.

  4. #3
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    Unfortunately I'm pretty sure my GP didn't bother to do an extensive panel for hormones. I have a feeling she doesn't really care about my symptoms. The other tests I got done were:

    Comp Metabolic Panel
    Lipid Panel
    Vitamin D, 25-Hydroxy 51.6 (30.0-100.0)
    CBC with Differential/Platelet
    TSH 1.140 (0.450-4.500)
    Hemoglobin A1c
    Testosterone, Serum 208

    I'm not sure if you guys need to see the comp metabolic, lipid, CBC, or hemoglobin. The only level that was out of range in any of those was A/G ratio which was 2.7 (1.2-2.2) and ALT was 51 (0-44). Pretty sure those have to do with liver though.

    That's another reason I'm here. I don't know what levels to do get tested and my doctor doesn't seem to know either.

  5. #4
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    Name:  comp metabolic panel.jpg
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  6. #5
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    Images were shrunk for some reason.. Can't post a link with better quality unless I have 4 or more posts.

  7. #6
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    All the blood tests I had done: http://imgur.com/a/TjoHd

    What else should I test for? I'm willing to do any necessary.

  8. #7
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    The most important things to check at this point would be prolactin and LH/FSH. If you have a prolactinoma, your prolactin will read insanely high. This is one of the leading causes of hypogonadism in young patients. LH/FSH will indicate whether or not your pituitary is functional. If there's no identifiable cause, you might be a good candidate for clomid. I wouldn't recommend jumping on testosterone unless you're absolutely ready for it. Also, a full thyroid panel might be helpful, but your TSH looks good.

  9. #8
    Moderator Vince's Avatar
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    You do have very low testosterone. Nelson has a thread on "Suggested Lab Tests and Questions Before and After Initiation of Testosterone Replacement" you may like to read over.
    https://www.excelmale.com/showthread...ne-Replacement
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  10. #9
    Yeah unfortunately those blood tests are extremely limited, and give very very little information about your hormonal situation.

  11. #10
    What ever you do please reconsider taking the testosterone once every 2 weeks. That will likely make you feel even worse then you already do and won't be a good long term protocol for you. For me twice a week (50mg twice weekly) was not enough frequency to get me stable and feeling really good. Take the time to read here and heed the advice from others here.

  12. #11
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    Alright guys, I got extensive blood work regarding most if not all of my hormones. I just went with the full meal-deal on DiscountedLabs for male hormone panel and thyroid hormone panel. Tell me your thoughts:

    http://imgur.com/EJfFXQG

    http://imgur.com/MKGaO94

    http://imgur.com/TjJXkDE

    In case those are not view-able:

    LH: 2.6
    FSH: 1.6
    Testosterone: 319
    Free Test: 8.1
    T4 Free, Direct S: 1.41
    DHEA-Sulfate: 273
    TSH: 1.130
    Prolactin: 8.5
    Prostate-Specific Ag, Serum: 0.6
    Reverse T3, Serum: 15.2
    Estradiol, Sensitive: 9.1
    Thyroglobulin Antibody: <1.0
    Thyroid Peroxidase (TPO) Ab: 13
    Triidothyronine, Free, Serum: 2.9

    Apparently my total testosterone went up roughly 100 points since I was tested last. That seems surprising but what do I know.

    My symptoms are still: fatigue, deep depression, anxiety, apathy, low confidence/self esteem. I'm wondering if these feelings can worsen testosterone and if so by how much.

    I'll be going to see a Urologist in 2 days and one of his specialties is TRT in older men. Unfortunately I'm a bit younger so I hope he can sort me out.

  13. #12
    Your testosterone is still on the low side but overall, and at your age, I would think a clomid run would be worth a try. I would probably recommend 3 months or so at 25 mg every other day or something like that, and I would seek a consult with an expert such as at Defy. They may want to be more aggressive. Now, let me say this. Clomid will limit estrogen inhibition of your HPTA, however, your estrogen levels are already quite low, and that may also be contributing to how you feel. So it would seem that it is unlikely your HPTA is estrogen inhibited. However, clomid is a little unpredictable so it would still be worth a try with your LH and FSH on the low side. If Clomid raises your testosterone levels, your E will come up also.

  14. #13
    Quote Originally Posted by TRT-209 View Post
    Alright guys, I got extensive blood work regarding most if not all of my hormones. I just went with the full meal-deal on DiscountedLabs for male hormone panel and thyroid hormone panel. Tell me your thoughts:

    http://imgur.com/EJfFXQG

    http://imgur.com/MKGaO94

    http://imgur.com/TjJXkDE

    In case those are not view-able:

    LH: 2.6
    FSH: 1.6
    Testosterone: 319
    Free Test: 8.1
    T4 Free, Direct S: 1.41
    DHEA-Sulfate: 273
    TSH: 1.130
    Prolactin: 8.5
    Prostate-Specific Ag, Serum: 0.6
    Reverse T3, Serum: 15.2
    Estradiol, Sensitive: 9.1
    Thyroglobulin Antibody: <1.0
    Thyroid Peroxidase (TPO) Ab: 13
    Triidothyronine, Free, Serum: 2.9

    Apparently my total testosterone went up roughly 100 points since I was tested last. That seems surprising but what do I know.

    My symptoms are still: fatigue, deep depression, anxiety, apathy, low confidence/self esteem. I'm wondering if these feelings can worsen testosterone and if so by how much.

    I'll be going to see a Urologist in 2 days and one of his specialties is TRT in older men. Unfortunately I'm a bit younger so I hope he can sort me out.
    When consulting a doctor for the first time, particularly in the area of male androgens, it's wise to prepare a list of questions related to now he or she manages patients on TRT protocols. Those questions will quickly reveal whether the person you're talking to is someone you can trust to help you reach your goal. You are hypogonadal, but you are very young. That opens lots of topics for consideration and conversation.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  15. #14
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    Quote Originally Posted by JPB View Post
    Your testosterone is still on the low side but overall, and at your age, I would think a clomid run would be worth a try. I would probably recommend 3 months or so at 25 mg every other day or something like that, and I would seek a consult with an expert such as at Defy. They may want to be more aggressive. Now, let me say this. Clomid will limit estrogen inhibition of your HPTA, however, your estrogen levels are already quite low, and that may also be contributing to how you feel. So it would seem that it is unlikely your HPTA is estrogen inhibited. However, clomid is a little unpredictable so it would still be worth a try with your LH and FSH on the low side. If Clomid raises your testosterone levels, your E will come up also.

    So seeing a urologist might not be the best option here? I'm extremely new to all this. I've been waiting on an appointment for weeks now so I'd still like to follow through. Should I ask him about Clomid?

  16. #15
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    Quote Originally Posted by CoastWatcher View Post
    When consulting a doctor for the first time, particularly in the area of male androgens, it's wise to prepare a list of questions related to now he or she manages patients on TRT protocols. Those questions will quickly reveal whether the person you're talking to is someone you can trust to help you reach your goal. You are hypogonadal, but you are very young. That opens lots of topics for consideration and conversation.
    Thank you but what kind of questions should I be asking? I really don't know the first thing about TRT

  17. #16
    UNfortunately what to ask is a common trap...you don't know right from wrong for what a "Dr" will tell you so there's this blackhole of do you trust the guy, or not. Just from above, Dr doesn't know what to test...how can some one treat you that can't run the right tests? That's a very bad sign. What I would suggest is take notes on your meeting...what therapy he uses (like injections or topical), how often, Estrogen management with Anastrozole (if needed), does he use HCG, what is his target for Total and Free T, Prostate testing, those are good questions to ask.

  18. #17
    Quote Originally Posted by Vince Carter View Post
    UNfortunately what to ask is a common trap...you don't know right from wrong for what a "Dr" will tell you so there's this blackhole of do you trust the guy, or not. Just from above, Dr doesn't know what to test...how can some one treat you that can't run the right tests? That's a very bad sign. What I would suggest is take notes on your meeting...what therapy he uses (like injections or topical), how often, Estrogen management with Anastrozole (if needed), does he use HCG, what is his target for Total and Free T, Prostate testing, those are good questions to ask.
    Expanding on my good friend, Vince Carter's, points, I'd be sure, given your age, to ask about the possibility of using Clomid as a restart protocol. How many patients has he managed on Clomid, something of a tricky undertaking requiring close monitoring of estradiol? Does he test estradiol via the appropriate lab test, LC, MS/MS, assay? Did he even know what you were talking about? Are patients on various protocols, some injecting every 3.5 days, some every other day, a few on daily injections, and some, possibly, on topicals? That would be a good sign. It means that the needs of the patient are accounted for and no cookie-cutter protocols are pushed out. Pay attention to his/her demeanour- does he seem defensive as you question him, or does he answer your questions openly?
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

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