35 year old, low testosterone, DVT

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TronM

New Member
Greetings all. I'm writing this post after I read Vergel's book, and I have some questions regarding low testosterone and TRT. This is all new to me and slightly confusing. I'm not sure what to make of it and what to do, whence this post.

Some background information: 35 year old male from Norway, 6'1", 192lbs. In December last year I was diagnosed with a DVT, and as part of the blood work I asked for a check on my testosterone levels. It turned out it was quite low, measured to 12 nmol/l or 346 ng/dl. A second test a few weeks after showed more or less the same, 11,5 nmol/l or 332 ng/dl. This time SHBG was measured as well, the value was 15 nmol/l. As far as I can tell, both the T levels and the SHBG are low. Blood work shows I do not have any known genetic predispositions for blood clotting.

I measured cholesterol as well, these are the values. Normal range in paranthesis:

HDL: 1,66 mmol/L (0,80 - 2,10)
LDL: 2,90 mmol/L (1,50 - 4,80)
Trigl: 0,76 mmol/L (0,45 - 2,60)
Total: 4,9

Metabolism was checked as well, and TSH was elevated at 6,2. T4 was within normal range at 15,3. This was about three months ago. If it's of any importance this was a stressful time for me with the DVT and some other life stuff, and I was in a caloric deficit as well. I see a preliminary study have found a correlation between DVT and subclinical hypothyroidism, but this is speculation on my part. This might be relevant for me, but I don't know. I don't have any symptoms of hypothyroidism though.

I checked again three weeks ago and TSH was now in normal range at 2,1. According to my doc TSH can fluctuate, so it's not necessarily a reason for concern. I don't know, for all I know this is all part of a bigger picture. There is a history of heart disease on my father's side, all his six brothers have had heart issues. If I've understood correctly, atherosclerosis may be a factor regarding DVT's. If so, I'm off to an early start with this problem, yay. From what I can tell men on TRT have less risk for heart problems than men with low T, so this is certainly an important factor for me.

My doc will now confer with an endocrinologist what the options are as far as the low T goes. He's not opposed to TRT, but not that knowledgable about it as he's "just" a normal general physician. After reading Vergel's book and reading on this website I see that there's a lot of blood tests that ought to be done, estradiol and so forth. Should I just ask my doc to do these? Or perhaps just get a referral to the endocrinologist directly?

I'm not opposed to TRT at all, but I am somewhat uncertain about it. Me and my girlfriend have decided to give reproduction a shot, so there's the added concern of my little swimmers as well. If I've understood this right, sperm count can go down after starting TRT unless you take additional drugs. Right now I'm leaning towards delaying TRT at least until me and my girl find if we're fertile or not. First things first.

Sorry for the long post. I tried to include relevant information without getting too specific. Any advice on how to proceed is much appreciated. I'm a bit confused by all of this, and the DVT thing really shook me up. Thanks.
 
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TronM

New Member
I have not had my sperm count tested, no. Standard procedure according to my doc is to try for about a year, and if still no go then testing will commence. Since we're somewhat late to the party (I'm 35, my girl is 34) I'm considering getting tested before we try for a year. The sooner the better, right?

Thanks for the tip on the DVT thread. I will post there once I have read some more and have formulated some relevant questions.
 

Gene Devine

Super Moderator
I think you should have a full blown Thyroid workup done.

Hypothyroidism can and will cause Hypogonadism...need to rule this out.

You need to look at:

TSH
Free T4
Free T3
Reverse T3
Thyroid Antibodies
 

TronM

New Member
Thanks for the input, Gene. I don't know why only TSH and T4 was measured. I forgot to mention that I did have an ultrasound exam of my testicles two weeks ago, as part of the testing for hypogonadism. Everything was normal.

Do you reckon it's OK using my general physician for the thyroid tests or would an endocrinologist be a better choice? My doc is already conferring with an endocrinologist, I'm just thinking if it would be better to cut out the middle man. I could probably ask for a referral if I wanted.
 

Gene Devine

Super Moderator
Thanks for the input, Gene. I don't know why only TSH and T4 was measured. I forgot to mention that I did have an ultrasound exam of my testicles two weeks ago, as part of the testing for hypogonadism. Everything was normal.

Do you reckon it's OK using my general physician for the thyroid tests or would an endocrinologist be a better choice? My doc is already conferring with an endocrinologist, I'm just thinking if it would be better to cut out the middle man. I could probably ask for a referral if I wanted.


Endo is better for Thyroid eval.

Just looking at TSH and T4 is not enough by a long shot.

You need both Free T4 and Free T3 as this is where the rubber meets the road with the Thyroid if you will.

Reverse T3 is critical as well as sometimes all looks good till you look at RT3 lab and it tells a completely different story?

Are you symptomatic?
 

TronM

New Member
Not really. I suppose that's a good thing. I'll get an appointment with an endocrinologist, thanks for the advice. When I look at the lab results maybe it was free T4 that was measured (FT4). I'll get the rest of the blood work done anyway.

2.january
S-FT4 15.3
S-TSH 6.24*

8.april:
S-FT4 15.7
S-TSH 2.07
 

Vettester Chris

Super Moderator
Yeah, totally agree with Gene on the labs. Also need the reference ranges, and unit of measurement to effectively calculate the ratio of Free T3 to Reverse T3.
 

TronM

New Member
Thanks Chris. This whole ordeal with the DVT, low T and fluctuating TSH is confusing and unsettling for me. I'm not sure what to make of it, and it's always in the back of my mind. I need to figure this out. I do have celiac's disease, and from what I've found there are signs that celiacs have higher risk of thyroid problems. I've been gluten free for 10 years now, though. It may be a factor anyway.

By chance I just learned that my employer has extra health insurance for all employees, so I will make use of that and get an appointment with an endocrinologist for the thyroid tests. I will report back here once the tests are done and results are in.

Thanks for the help everyone, it's much appreciated.
 
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