How to approach my situation with my doctor?

[donsdawn]

Hello everyone! I am a 18 year old male. I weigh 158 pounds and my body fat percentage is 10%. I used to be pretty overweight at 200 pounds with little to no muscle mass, but I’ve fixed that since last year. I lift 5x5 3 times a week and I also get a lot of walking done per day on campus.
Recently I’ve been concerned that I’m experiencing symptoms of low T. I’ve had little to no libido this past year, my skin is very dry, it’s difficult to get and maintain an erection with my girlfriend, no morning wood, trouble sleeping, irritability, lack of focus.
I eat about 2700 calories a day with more than sufficient protein, at least 150+ carbs, and healthy fats from nuts and avocados.
Here’s my recent bloodwork: https://imgur.com/a/F3dvLh3 5

I have an appointment scheduled through Kaiser tomorrow to meet with a doctor regarding my symptoms and Total T levels. I am very nervous about getting the response that my levels are normal just because they are in range. I know that I need more blood work done such as a thyroid panel as well as Free T and SHBG. Should I ask for these tests? How do I go about a situation where the doctor tells me I am fine?

 

[Blackmar401]

Tell him you plan on paying to have them done and going with a telemedical clinic if he doesn't feel comfortable treating you. He may feel you are young and want to treat you so you don't just turn into a number at a clinic on lifelong treatment you may not need.

 

[Systemlord]

Beware the Kaiser endocrinology department is a joke, they have no clue how to administer TRT, little knowledge and are a poor choice for TRT. I have Kaiser and is useless for my TRT. I hear only horror stories from other Kaiser members, you need to seek private care from someone who specializes in TRT.

Your estrogen testing methodology (Roche ECLIA methodology) is the wrong test, men need the Liquid Chromatography–Mass Spectrometry or known as sensitive estrogen test since the former picks up on other steroids (C-reactive protein) as estrogen therefore falsely elevating your estrogen score.

If you have an HMO, it's useless for TRT!

 

[fifty]

Good luck with that one. Your numbers are all normal and you're 18. Your family doc is unlikely to treat you. Blackmar401's advice is interesting. Try that and see what your doc says.

That being said I would be leery of going on TRT at age 18.

 

[Sean Mosher]

Did you have Free T tested?
I didn't see that in your link.

I'd also take a look at thyroid.
Need to be able to consider and/or rule out anything and everything.

 

[Ardoc2]

As said above.... check thyroid. To have made the progress you've made with your weight loss (Kudos BTW) the caloric restriction that must have been necessary to accomplish this, especially for an extended period of time, could have affected your thyroid hormones. My reverse T3 goes high when I do Keto or restricted calorie diet. Seems that a lot of people now advise to deal with Thyroid first and then consider TRT if still necessary.

 

[donsdawn]

Thanks guys. I actually rescheduled my appointment for tomorrow, so I'll try to get a thyroid lab from the doc, and maybe Free T and SHBG as well.

 

[donsdawn]

UPDATE: He ordered labs for Total T, Free T, SHBG, and TSH.
Results were taken at 9 A.M

Total T: 378 ng/dL
Reference Range - 276-941 ng/dL
Testosterone Free Calculated: 7.7 ng/dL
Reference Range - 7.0-36.7 ng/dL
SHBG: 32 nmol/L
Reference Range - 11-78 nmol/dL

TSH: 2.27 mcIU/mL
Reference Range - 0.35 - 4.00 mcIU/mL


LOL. Advice on the next step to take?

 

[Systemlord]

UPDATE: He ordered labs for Total T, Free T, SHBG, and TSH.
Results were taken at 9 A.M

Total T: 378 ng/dL
Reference Range - 276-941 ng/dL
Testosterone Free Calculated: 7.7 ng/dL
Reference Range - 7.0-36.7 ng/dL
SHBG: 32 nmol/L
Reference Range - 11-78 nmol/dL

TSH: 2.27 mcIU/mL
Reference Range - 0.35 - 4.00 mcIU/mL


LOL. Advice on the next step to take?

Your levels decreased quite a bit since your first blood testing, you definitely have something going on with your pituitary gland. Poor sleep and or sleep apnea can cause low testosterone, does your girlfriend know if you snore when sleeping?

Do you have any prolactin tests?

 

[Vince]

It's too bad you didn't have a complete thyroid panel. TSH, free T4, free T3, reverse T3 and both antibodies.

You definitely have low testosterone, especially for young man of 18 years old.

 

[donsdawn]

The doctor ordered new labs for Free T4 and T3, as well as TSH again.

TSH: 1.53 mcIU/mL
Reference Range is 0.35 - 4
Free T4: 0.9 ng/dL
Reference Range is 0.8 - 1.5
T3: 73 ng/dL
Reference Range is 80-210

 

[Systemlord]

The doctor ordered new labs for Free T4 and T3, as well as TSH again.

TSH: 1.53 mcIU/mL
Reference Range is 0.35 - 4
Free T4: 0.9 ng/dL
Reference Range is 0.8 - 1.5
T3: 73 ng/dL
Reference Range is 80-210

I would have preferred to see Free T3 and not T3 tested, Kaiser is a little bit behind here. T3 is very low and is responsible for increasing metabolism and increasing body temperatures. You can expect dry skin, fatigue, feeling cold etc. All symptoms for low testosterone and low thyroid are the same.