25 year old with low T symptoms and bloodwork

[yesman]

Hi all,

Link to bloodwork: imgur.com/ht6Lj2M

Background: So after dealing with symptoms of low testosterone for several months I set up an appt with my doctor. I described how I was lacking drive/motivation, feeling constantly run down, and suffering from low libido, etc. I mentioned that I researched symptoms and discovered that they align with symptoms of low T and requested a blood test to check my levels. Instead she ordered a metabolic panel and thyroid panel and everything came back normal. Her advice was to give my symptoms time to go away and that these feelings are normal. I was sitting there thinking that no way are these normal feelings to experience for such a long duration, especially at 25 years old.


I finally decided to take matters into my own hands and ordered bloodwork online. Now that I see the results I am looking for advice on the next steps that I should take. Like I said, I'm only 25 years old and overall very healthy but I feel like I've lost my spark and now have blood work showing low T.

My primary concern is the cause of these symptoms and results, especially since I'm only 25. I should mention that I eat healthy, exercise regularly, get enough sleep, and don't drink alcohol. I feel like I'm doing everything right but still suffering. Next I'm wondering how I should start treating these symptoms. Is it a waste of time to go back to a general doctor? Should I go to a urologist or endo? Maybe find an anti-aging clinic?

I really don't know what to do next so I'm looking for any suggestions. Thanks.

 

[James]

Probably a couple different route you can go, especially somebody your age. In my experience a urologist tends to be a little more testosterone knowledgeable and friendly than an endocrinologist. But who knows, tough to say at your age. The other guys will chime in. Search this site and Google Clomid & HCG and educate yourself on your most likely options.

 

[CoastWatcher]

Welcome to Excelmale. A housekeeping note, until you have a minimum number of posts you can't attach a link. That is an anti-spam/anti-ad feature. I raise that because I couldn't open your bloodwork link. You are young to present with low testosterone. That means it is all the more important that you don't, through no fault of your own, wind up seeking treatment from someone who isn't fully versed in contemporary androgen therapy. For example, depending on your lab results - which will give some idea if you are showing up with primary or secondary hypogonadism - a Clomid restart, an effort to reboot your own natural testosterone, production may be in order. That takes a skilled doctor...as does this whole exercise, frankly.

So, what to do? Where do you live? Do you have the (reasonable) financial resources to commence treatment with a doctor who works outside the insurance system? Two of the very best at Defy Medical practice nationally via telemedicine (Defymedical.com). We have had some success connecting patients to local doctors, but there are far more physicians without a clue than you might think.

Spend some time reading the vast material here on the Forum, post up your labs, and the discussion will start.

 

[yesman]

Yeah I thought the link to the bloodwork could be manually copied into the address bar but it doesn't work. Anyways my results show the following:
Testosterone, Serum
Testosterone, Serum 291 LOW 348-1197 ng/dL
Comment: Comment 01Adult male reference interval is based on a population of lean malesup to 40 years old.

Luteinizing Hormone(LH), S
LH 3.2 1.7-8.6 mIU/mL

FSH, Serum
FSH 2.1 1.5-12.4 mIU/mL

 

[yesman]

Welcome to Excelmale. A housekeeping note, until you have a minimum number of posts you can't attach a link. That is an anti-spam/anti-ad feature. I raise that because I couldn't open your bloodwork link. You are young to present with low testosterone. That means it is all the more important that you don't, through no fault of your own, wind up seeking treatment from someone who isn't fully versed in contemporary androgen therapy. For example, depending on your lab results - which will give some idea if you are showing up with primary or secondary hypogonadism - a Clomid restart, an effort to reboot your own natural testosterone, production may be in order. That takes a skilled doctor...as does this whole exercise, frankly.

So, what to do? Where do you live? Do you have the (reasonable) financial resources to commence treatment with a doctor who works outside the insurance system? Two of the very best at Defy Medical practice nationally via telemedicine (Defymedical.com). We have had some success connecting patients to local doctors, but there are far more physicians without a clue than you might think.

Spend some time reading the vast material here on the Forum, post up your labs, and the discussion will start.

I am located in Scottsdale, AZ. I've read a little about Defy and that's definitely an option for me. I would prefer finding a local doctor and using my health insurance but I'll consider all options.

 

[PAUL-E]

Any prior ASS or pro-hormone use?
Have you tested TSH, free t3, free t4, and reverse t3?
check this out:https://www.excelmale.com/forum/sho...e-and-During-Testosterone-Replacement-Therapy
giving your age and your LH/FSH defy has a restart program that might work for you.

 

[CoastWatcher]

Yeah I thought the link to the bloodwork could be manually copied into the address bar but it doesn't work. Anyways my results show the following:
Testosterone, Serum
Testosterone, Serum 291 LOW 348-1197 ng/dL
Comment: Comment 01Adult male reference interval is based on a population of lean malesup to 40 years old.

Luteinizing Hormone(LH), S
LH 3.2 1.7-8.6 mIU/mL

FSH, Serum
FSH 2.1 1.5-12.4 mIU/mL

In addition to the thyroid tests PAUL-E referenced, it would be good (at a minimum) to capture your free testosterone, SHBG, and estradiol (be sure it is the sensitive, LC, MS/MS Test that is performed).

 

[yesman]

Any prior ASS or pro-hormone use?
Have you tested TSH, free t3, free t4, and reverse t3?
check this out:
giving your age and your LH/FSH defy has a restart program that might work for you.

No prior aas or ph use. I had full thyroid panel done when I brought up my symptoms to my regular doc and everything was normal.

 

[CoastWatcher]

I am located in Scottsdale, AZ. I've read a little about Defy and that's definitely an option for me. I would prefer finding a local doctor and using my health insurance but I'll consider all options.

PrimeBody has a Scottsdale location. They work on a fee-for-service basis, however.

 

[yesman]

PrimeBody has a Scottsdale location. They work on a fee-for-service basis, however.

Yeah I'm researching local doctors so I can use insurance but it's great knowing the PrimeBody is here as well.

 

[yesman]

This site is great to look through and research. Also go to Life Extension Foundation at www.lef.org Look up Low T and TRT. They have researched articles and some non-T things you can try too. Similar to what's recommended here too.

Regardless of what you try, Exersize, lift weights. Free weights, not machines. Lose weight. All of the fat must go. No more than 1 or 2 drinks of booze per day. Better yet, just stop. No smoking. Synthetic Marihoochie will cause schizophrenia. You gotta detox that stuff outa your body. Zero drugs.

Not sayin you do or not - these things can help a lot for a guy. You're gonna wake up some morning and you're 50. How you are then depends on how you live today.

Its great you're looking into your health now. That really matters.

You make a great point about how we feel when we're older depends on our lifestyles when we're younger. That said, I lift weights and perform cardio several times per week, follow a well-planned diet, and don't drink. I take excellent care of my body so I'm struggling with understanding why I have bloodwork and symptoms of low T at only 25 years old. Hopefully I find a some answers and solutions!

 

[yesman]

Here's a working link to bloodwork, now that I've met the minimum post requirement: http://imgur.com/ht6Lj2M

As mentioned before, I also had a full thyroid panel and everything looked good.

 

[Vitamin_C]

I am located in Scottsdale, AZ. I've read a little about Defy and that's definitely an option for me. I would prefer finding a local doctor and using my health insurance but I'll consider all options.

I am also in Scottsdale, AZ. I go to Dr. Bartels with vitality hormones for men for part of my TRT care, I use my insurance for him. I use Defy for a portion as well, used my insurance for labs. Their medications are too expensive but I can get them cheaper through my prescribing TRT physician and my insurance covers my testosterone for $10 for a 6 week supply. HCG I get through a local compounding pharmacy.



http://www.scottsdalebioidenticaldoctor.com/scottsdale-bioidentical-hormone-doctor/

 

[Dr. Rob Kominiarek]

Dear Yesman,

Here is your freebie. Very rarely do I comment but I just had surgery yesterday and I'm housebound and bored. Before you see some physician that "dabbles" in hormones that leads you down the wrong path, these are the labs you "must" have completed prior to the institution of any therapy and if any physician you see does NOT understand why they need these labs....well, find a new physician.

Performed fasted at 8AM

Growth Hormone
IGF-1
IGF BP-3
DHEA-S
Testosterone Free & Total
DHT
SHBG
PSA with reflexed % Free PSA
Estrone
Estradiol
Pregnenolone
Progesterone
FSH
LH
Prolactin
Zinc
Copper
B12
Folate
Insulin
Vitamin D3
TSH
T3, free
T4, free
rT3
TPO
ACTH
Cortisol AM
Iron

*Perform a Heavy Metal Exposure Panel if DHEA-S is elevated
*Perform a GST if IGF-1 is 84 or lower or if cortisol is less than 5

Looking at your initial LH/FSH you have suffered some hypothalamic-pituitary insult, but you are missing the necessary labs to help pinpoint the potential location: i.e. is it destruction of the PVN of the hypothalamus? The question is what and why? Is it a failure of the H-P axis to be in homeostasis from radiation, chemotherapy, autoimmune disorder, infection, tumor, pharmaceuticals, toxin exposure, illicit drug use, prior testosterone usage, genetics, or traumatic brain injury (even concussions without loss of consciousness). The causes are numerous but identifiable if you really dig into your past medical history. For example, just 1 CT scan with iodinated contrast material performed for any reason would be enough to knock out your H-P axis.

First, have all the labs completed. Second, see a physician who specializes in this field. Third, really dig for the potential cause(s), you're only 25. Fourth, if unable to find a "removable cause" to your H-P axis dysfunction your initial therapy should be with clomiphene citrate 25mg every 3rd day for 8-12 weeks and then repeat labs.

Recommendations for physicians that know the data and that I see regularly at "tip of the spear meetings", close to you is Mark Gordon in California, John Crisler in Michigan and Florida and then myself in Ohio and Utah. None of us accept insurance and there is reason(s) as to why!

Now time to change my bandages!

All the Best,

Dr. Rob

 

[Vitamin_C]

Dear Yesman,

Here is your freebie. Very rarely do I comment but I just had surgery yesterday and I'm housebound and bored. Before you see some physician that "dabbles" in hormones that leads you down the wrong path, these are the labs you "must" have completed prior to the institution of any therapy and if any physician you see does NOT understand why they need these labs....well, find a new physician.

Performed fasted at 8AM

Growth Hormone
IGF-1
IGF BP-3
DHEA-S
Testosterone Free & Total
DHT
SHBG
PSA with reflexed % Free PSA
Estrone
Estradiol
Pregnenolone
Progesterone
FSH
LH
Prolactin
Zinc
Copper
B12
Folate
Insulin
Vitamin D3
TSH
T3, free
T4, free
rT3
TPO
ACTH
Cortisol AM
Lead

*Perform a Heavy Metal Exposure Panel if DHEA-S is elevated
*Perform a GST if IGF-1 is 84 or lower or if cortisol is less than 5

Looking at your initial LH/FSH you have suffered some hypothalamic-pituitary insult, but you are missing the necessary labs to help pinpoint the potential location: i.e. is it destruction of the PVN of the hypothalamus? The question is what and why? Is it a failure of the H-P axis to be in homeostasis from radiation, chemotherapy, autoimmune disorder, infection, tumor, pharmaceuticals, toxin exposure, illicit drug use, prior testosterone usage, genetics, or traumatic brain injury (even concussions without loss of consciousness). The causes are numerous but identifiable if you really dig into your past medical history. For example, just 1 CT scan with iodinated contrast material performed for any reason would be enough to knock out your H-P axis.

First, have all the labs completed. Second, see a physician who specializes in this field. Third, really dig for the potential cause(s), you're only 25. Fourth, if unable to find a "removable cause" to your H-P axis dysfunction your initial therapy should be with clomiphene citrate 25mg every 3rd day for 8-12 weeks and then repeat labs.

Recommendations for physicians that know the data and that I see regularly at "tip of the spear meetings", close to you is Mark Gordon in California, John Crisler in Michigan and Florida and then myself in Ohio and Utah. None of us accept insurance and there is reason(s) as to why!

Now time to change my bandages!

All the Best,

Dr. Rob

I routinely have DHEA-S in the 400's and 500's, is there a correlation with elevated DHEA-S and exposure to heavy metals? Dr. Crisler has seen my labs, my last DHEA-S was in the 500s

 

[Dr. Rob Kominiarek]

Vitamin_C!

I routinely have DHEA-S in the 400's and 500's, is there a correlation with elevated DHEA-S and exposure to heavy metals? Dr. Crisler has seen my labs, my last DHEA-S was in the 500s

If you are taking DHEA supplementation the answer is no. If you are not taking DHEA supplementation the answer is potentially Yes, as there is a correlation with mercury exposure/toxicity and increased DHEA-S levels. However, I don't know your age and other labs, you just may be one of the fortunate who's gonads, adrenals and glia cells make abundant levels of DHEA, which is awesome! John is a good doc and another "hormone nerd" like myself, he knows this stuff.

All the Best!

Dr. Rob
ReNue Health

 

[Vitamin_C]

Vitamin_C!

I routinely have DHEA-S in the 400's and 500's, is there a correlation with elevated DHEA-S and exposure to heavy metals? Dr. Crisler has seen my labs, my last DHEA-S was in the 500s

If you are taking DHEA supplementation the answer is no. If you are not taking DHEA supplementation the answer is potentially Yes, as there is a correlation with mercury exposure/toxicity and increased DHEA-S levels. However, I don't know your age and other labs, you just may be one of the fortunate who's gonads, adrenals and glia cells make abundant levels of DHEA, which is awesome! John is a good doc and another "hormone nerd" like myself, he knows this stuff.

All the Best!

Dr. Rob
ReNue Health

Very interesting info. I am not taking OTC DHEA, my levels have always been in the upper range naturally, even with my pre TRT total testosterone numbers of 400's-500's, I am 33 years old and in good physical shape. No abnormalities on any other labs but I have not had a heavy metal panel. This may be the reason that I had good erections and libido even with my total test was in the 300's 400's..

 

[yesman]

Dr. Rob,

Thank you for taking the time to type up such a detailed response; I really appreciate this info. I completely agree that I need to find a physician who will spend the time to find root cause rather than just prescribe TRT and send me on my way. You listed a variety of potential causes and that I need to explore further; some previous medial events that occurred when I was younger immediately came to mind. I'm still searching locally for a doctor and AZ and can hopefully schedule an appointment soon.

I hope you quickly recover from your surgery!

 

[Dr Justin Saya MD]

Dr. Rob,

Thank you for taking the time to type up such a detailed response; I really appreciate this info. I completely agree that I need to find a physician who will spend the time to find root cause rather than just prescribe TRT and send me on my way. You listed a variety of potential causes and that I need to explore further; some previous medial events that occurred when I was younger immediately came to mind. I'm still searching locally for a doctor and AZ and can hopefully schedule an appointment soon.

I hope you quickly recover from your surgery!

Yesman - also look into the possibility of sleep apnea (central or obstructive). I find that as many as 10-20% of very young (<30yo) males presenting with these classic symptoms and suppressed HPTA ultimately end up being diagnosed with some degree of sleep apnea. This is especially true if you snore at night and/or wake up still feeling fatigued and have neck size >17".