Seconday Hypogonadism?

thouman · Apr 18, 2018

30 years old. Try to maintain a healthy lifestyle. Good diet, little alcohol, exercise, etc. Started to suspect something was wrong with me based on several issues. Ordered some blood tests, showed them to my doctor, she agreed testosterone was low and wanted to test again. She said I was fine after the second test but it seems to me given the low testosterone levels and low FSH and LH I might have secondary hypogonadism. What are your thoughts?

Issues:

Strength training progress pathetic despite sticking to schedule religiously and maintaining a good diet for 6 years
Struggle to lose fat without losing tons of strength
Seem to have a disproportionate amount of visceral fat
lethargy
get very sleepy in afternoons into the evening starting from 3-5pm despite 8-9 hours of sleep the night before
lack of enjoyment of things I used to enjoy
irritability

Libido seems fine.

[TABLE="width: 500"]
[TR]
[TD]Test
[/TD]
[TD]Value
[/TD]
[TD]Ref. Range
[/TD]
[TD]Units
[/TD]
[/TR]
[TR]
[TD]Total Testosterone
[/TD]
[TD]249
[/TD]
[TD]264-916
[/TD]
[TD]ng/dL
[/TD]
[/TR]
[TR]
[TD]Free Testosterone
[/TD]
[TD]9.49
[/TD]
[TD]5-21
[/TD]
[TD]ng/dL
[/TD]
[/TR]
[TR]
[TD]Estradiol, Sensitive
[/TD]
[TD]18.4
[/TD]
[TD]8-35
[/TD]
[TD]pg/mL
[/TD]
[/TR]
[TR]
[TD]IGF-1
[/TD]
[TD]261
[/TD]
[TD]98-282
[/TD]
[TD]ng/mL
[/TD]
[/TR]
[TR]
[TD]TSH
[/TD]
[TD]1.490
[/TD]
[TD]0.45-4.5
[/TD]
[TD]uIU/ml
[/TD]
[/TR]
[TR]
[TD]Thyroxine (T4)
[/TD]
[TD]7.6
[/TD]
[TD]4.5-12.0
[/TD]
[TD]ug/dL
[/TD]
[/TR]
[TR]
[TD]T3 Uptake
[/TD]
[TD]29
[/TD]
[TD]24-39
[/TD]
[TD]%
[/TD]
[/TR]
[TR]
[TD]Free Thyroxine Index
[/TD]
[TD]2.2
[/TD]
[TD]1.2-4.9
[/TD]
[TD]ng/dL
[/TD]
[/TR]
[TR]
[TD][/TD]
[TD][/TD]
[TD][/TD]
[TD][/TD]
[/TR]
[/TABLE]

Doctor Ordered tests
[TABLE="width: 500"]
[TR]
[TD]Total Testosterone
[/TD]
[TD]369
[/TD]
[TD]132-813 (132 wtf?)
[/TD]
[TD]ng/dL
[/TD]
[/TR]
[TR]
[TD]LH
[/TD]
[TD]0.8
[/TD]
[TD]no reference range
[/TD]
[TD]mIU/mL
[/TD]
[/TR]
[TR]
[TD]FSH
[/TD]
[TD]1.16
[/TD]
[TD]1.55-9.74
[/TD]
[TD]mIU/mL
[/TD]
[/TR]
[/TABLE]

Vettester Chris · Apr 18, 2018

Can you verify the total test serum result? Your post says 369ng/dl, but you have the 132wtf noted to the right lol.Plus, the first labs said 249ng/dl. With that LH result, I would almost expect a lower total test score than 369ng/dl?? But everyone is different ...

Also, any thyroid test that has "uptake" or "index" is totally useless. It's the easy route for a doctor to say, "everything is in range". In addition to the TSH you need Free T4, Free T3, Reverse T3 and Antibodies (TPO and TgAb).

Welcome to Excel Male

thouman · Apr 18, 2018

First test 249 ng/dL, second test 369 ng/dL. The "132 wtf?" note was supposed to express how I think it's strange my doctors lab has 132 as the bottom of the reference range. Seems really low. I can get a proper thyroid test in a few days per your suggestion.

ratbag · Apr 19, 2018

Were both sets of labs from the same place? It's strange they would use different ranges.

thouman · Apr 19, 2018

I dont think so. First tests were Labcorp. I believe my doctor's office network has their own lab.

Systemlord · Apr 19, 2018

You have the hormone levels of a elderly man and your doctor is uninformed. The average levels for someone your age is north of 600 ng/dL, your doctor doesn't really understand proper labs testing for thyroid or testosterone testing do to the fact SHBG was missed. SHBG is the gold standard for sex hormone testing, it tells us how well you hold onto your testosterone. Even if your doctor prescribe you TRT, she wouldn't know the first thing about how to monitor and properly balance your hormones.

It's time to move on to greener pastures and find a doctor who's head isn't buried in the sand. Expect most doctors to fail at TRT, most have no idea what a modern TRT protocol looks like or how to tailor a protocol based off you blood biomarkers, most will provide cookie cutter protocols designed for everyone. This often fails.

https://www.ncbi.nlm.nih.gov/pubmed/27843074

CONCLUSION:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

captain · Apr 19, 2018

Prolactin level should be in your next labs.

Dave B. · Apr 19, 2018

I had numbers similar to yours and am 15+ years older than you. My physician told me I needed to go see a specialist and referred me to an endocrinologist for more testing. At your age, with those numbers, your doctor should be doing the same.

Also, this forum is great but don't substitute google searches and forum wisdom for a skilled practitioner. Some people live in remote areas or are under-served for various reasons, and rely on remote doctors and forums. Just see a good doc if you can, is all I'm saying.

Also "good diet" could mean anything. Maybe a vegan who hasn't eaten an egg yolk in 6 years is a "good diet" and yet is starving the body of cholesterol. Or maybe you have pre-diabetes or genetic insulin resistance? Diet is great but genetics is a whole other story. Maybe you microwave every meal in plastic and cook in teflon pans, and use hand-sanitizer 10 times per day and have chemicals interfering with your hormones. Way too many things could be going on to just point to a couple of numbers on a test. Some people look for functional medicine doctors or nutritionists to help straighten out hormonal issues, so that's another area you could investigate. As young as you are I would think a doctor would look hard at other causes before assuming age-related decline or something "natural" (ironic quotes) is causing testosterone to be low. So maybe your doc is being extra cautious before considering TRT, rather than being merely ignorant. Putting a young person on lifetime therapy isn't ideal, as they say.

Best of luck!