Low T, High TSH, Feel Terrible

WingZeroCustom89 · May 8, 2017

I am 28 years old, 170lbs, 5'8" and have been feeling fairly depressed and down for years. I also have libido issues in that I am never in the mood. This is completely different from my early 20s and trying to figure out what is going on. These symptoms have been around for ~3 years now.

I recently went to the doctor to test for low t and the results came back as this. (Results are from LabCorp.)

Item, Current Amount, Units, Typical Range
Bilirubin Total, 0.3, mg/dL, (0.0-1.2)
Alkaline Phosphatase S, 53, IU/L, (39-117)
AST (SGOT), 27, IU/L, (0-40)
ALT (SGPT), 27, IU/L, (0-44)
TSH, 4.280, uIU/mL, (0.450-4.500)
LH, 2.2, mIU/mL, (1.7-8.6)
Prolactin, 8.5, ng/mL, (4.0-15.2)
Neutrophils, 3.5, x10E3/uL, (1.4-7.0)
Lymphs, 1.6, x10E3/uL, (0.7-3.1)
Monocytes, 0.4, x10E3/uL, (0.1-0.9)
Eos, 0.1, x10E3/uL, (0.0-0.4)
Baso, 0.0, x10E3/uL, (0.0-0.2)
SHBG, 33.9, nmol/L, (16.5-55.9)
Estradiol, 28.5, pg/mL, (7.6-42.6)
Total T, 344, ng/dL, (350-1000)
PSA, 0.43, ng/mL, (< 4.0)
Free T, 6.78

*Roche ECLIA methodology

The test was done first thing in the morning after plenty of rest and no foods before the test was taken. I also refrained from eating anything after 9pm the night before.

Is TRT a viable option? What suggestions would you give on this situation? I would prefer to not have to deal with shots or gel forever but at the same time I would like to feel better. Has anyone been in a similar situation and know of any other options that I might have?

Thanks for the help!

CoastWatcher · May 8, 2017

WingZeroCustom89 said:
I am 28 years old, 170lbs, 5'8" and have been feeling fairly depressed and down for years. I also have libido issues in that I am never in the mood. This is completely different from my early 20s and trying to figure out what is going on. These symptoms have been around for ~3 years now.

I recently went to the doctor to test for low t and the results came back as this. (Results are from LabCorp.)

Item, Current Amount, Units, Typical Range
Bilirubin Total, 0.3, mg/dL, (0.0-1.2)
Alkaline Phosphatase S, 53, IU/L, (39-117)
AST (SGOT), 27, IU/L, (0-40)
ALT (SGPT), 27, IU/L, (0-44)
TSH, 4.280, uIU/mL, (0.450-4.500)
LH, 2.2, mIU/mL, (1.7-8.6)
Prolactin, 8.5, ng/mL, (4.0-15.2)
Neutrophils, 3.5, x10E3/uL, (1.4-7.0)
Lymphs, 1.6, x10E3/uL, (0.7-3.1)
Monocytes, 0.4, x10E3/uL, (0.1-0.9)
Eos, 0.1, x10E3/uL, (0.0-0.4)
Baso, 0.0, x10E3/uL, (0.0-0.2)
SHBG, 33.9, nmol/L, (16.5-55.9)
Estradiol, 28.5, pg/mL, (7.6-42.6)
Total T, 344, ng/dL, (350-1000)
PSA, 0.43, ng/mL, (< 4.0)
Free T, 6.78

*Roche ECLIA methodology

The test was done first thing in the morning after plenty of rest and no foods before the test was taken. I also refrained from eating anything after 9pm the night before.

Is TRT a viable option? What suggestions would you give on this situation? I would prefer to not have to deal with shots or gel forever but at the same time I would like to feel better. Has anyone been in a similar situation and know of any other options that I might have?

Thanks for the help!

Welcome to Excelmale. You have, particularly for someone not yet 30 years old, remarkably low free and total testosterone. TRT is typically a life-long commitment, but before you race into it there are a number of things that need further consideration. First of all, you have a very high TSH, thyroid problems need to be addressed prior to commencing TRT because in many cases correcting an abnormal thyroid can do wonders. But that means you need more testing - t3, t4, rt3, as well as TPo and TgAB antibodies. The TSH isn't enough to know where the problem lies, but there is certainly a problem.

In fact, you need a number of additional tests. You should have prolactin, CBC, DHEA, DHT, and the four-tube cortisol labs run. Your doctor ordered the incorrect estradiol test, the range is a dead give-away, you want the sensitive, LC, MS/MS, test run; it is the only reliable test for estradiol in men. What is your sleep like - is there any chance you have sleep apnea?

Does your doctor have experience in managing patients with male hormone issues? You're presenting with hypogonadism, some sort of hypothyroidism, and it's open as to what else. You deserve good care.