Very low T in mid-twenties

snorgejr · May 5, 2018

Hello!

I'm a 25 year old, norwegian male. I've been experiencing close to all the symptoms of low T to a greater or lesser extent for the last 5 years or so. They've been most notable for the past 1-2 years, with a constant increase in severity as time goes by. The most notable symptoms are:

Very low sex-drive (almost non-existent)
I can't remember the last time I had a morning erection
Reduced motivation to do work and excersise
Increasing problems with focusing on things for more than a few minutes at a time (brain fog? Not familiar with the term.)
Generally feeling a bit "under the weather"

I did a non-related blood test a year ago, for which the doctor gave me a "all looks good"-response:

Then a second one this april:

The units are not given, yet I'm quite sure the Total T ("S-TESTOSTERON" and "S-TESTOS") is measured in nmol/L. The same goes for SHBG. As for the free-T ("FRI TESTOSTERON INDE" and "FTINDEKS") I'm not sure.

I had a consultation with my doctor last week - on my initiative - to attempt to find a solution to the problem. She was very sceptical, to say the least, as I have built up an above average muscle mass after 7 years of strict diet and training. I've never touched any exogenous hormones or anything remotely similar, nor have I taken any medication outside of antibiotics. It seems my T-levels are about that of a 60-70 year old, yet according to my doctor it is "within normal ranges".

My life style is very healthy. I sleep 8+ hours every night, while sticking to the same sleeping schedule throughout the whole week. I eat low processed foods, enough quality fats, barely touch alcohol, I'm not obese, and I'm doing strength focused excersise x5/wk. I've not had any strength increase for about 2 years, despite bringing a lot of focus and energy to the gym. The only apparent thing I'm doing which might be detrimental to my T-levels is studying at the university, thus having periods of stress.

I have a history of being slightly overweight, with a BMI around 30 in the past. I'm in the normal range as of today, yet it has proven impossible to lose fat around my mid-section area. Not sure if this is a symptom of low T or not, but it's very unlikely to be a result of my diet not being on point.

Now to my questions:

Can low T be the reason for my symptoms, and what might the cause be?
Does it seem like TRT might be a possible solution to the problem, despite my young age?
Does anyone have experience with TRT from the public health care in Norway? It seems they are incredibly reluctant to help.
If "no" on question 3: What about the private sector?
Will me getting TRT at such a low age have potential negative effects on my fertility?

Any help would be greatly appreciated. This is really tearing on my quality of life.

Systemlord · May 5, 2018

Impossible to see labs. Low testosterone is an epidemic across the globe, the causes are many, poop sedentary lifestyles, living in toxic environment, pesticides, food preservatives, take your pic. It's not just affecting all life but our planet's weather. Western civilization will most likely be infertile in the next 30 years and we'll be adopting children from other poor countries.

The problem we men have with regards to TRT is doctors aren't trained to do TRT in medical school, they don't cover male hormone at all. Sad truth is there's just no money in it, doctors aren't going to waste time in medical school when TRT doesn't make enough profit to pay these doctor salaries, big pharma is who puts these doctors through medical school and they push prescription drugs, not hormones.

You speak to your doctor about depression, here's an SSRI, erectile dysfunction, here's Viagra, testosterone deficiency, you're within the normal ranges BS. There never measured your hormones before they gave you the SSRI. Big pharma is in control here, of the doctors.

This is why doctors are mostly clueless about how to properly diagnose a testosterone deficiency, most don't know what all tests are need, so they run minimal testing and are acting on information with holes in it. In short they really don't know what their doing, but their doing the best they know how with what little information there is on male hormones.

There's a black hole of information for doctors to access regarding TRT and are afraid of getting sued for giving TRT to someone who didn't really need it. All the doctors know about testosterone is body builders use it to get big, so now it's tainted or taboo even before you land that doctors appointment.

snorgejr · May 5, 2018

Thanks for the reply! Here is a summary of the testosterone-related bloodwork results, with the corresponding reference values:

17.01.2017:
Total-T: 7 (8-35)
SHBG: 37 (8-60)
Free-T: 1.9 (2.3-9.9)

16.04.2018:
Total-T: 8
SHBG: 38
Free-T: 2.4
(same reference values, obviously)

I also edited the original post with a bit better image quality.

CoastWatcher · May 5, 2018

Welcome to Excelmale. Your labs, particularly the first set posted, are very difficult to read. The second set certainly points toward hypogonadism. Did you run FHS and LH (Follicle Stimulating Hormone and Luteinizing Hormone)? That sheds light on the issue of primary or secondary origin. Any thyroid labs beyond TSH?

Systemlord · May 5, 2018

We need the units and ranges please. Going to assume it's nmol/L for testosterone, quite low indeed. Your scoring in the ranges I scored when I felt like I was dying. Most 80 year old have higher levels and younger men need more testosterone, but as we age we need less. Typical testosterone for someone your age is of 600+ ng/dL or 25 nmol/L. Our testosterone peaks in our 30's and begins a slow decline, your decline has started many years too early.

snorgejr · May 5, 2018

As for the units, they were not given. From my own research, the only thing which made sense regarding the T-values were nmol/L, as stated in my original post. Not so sure about the free-T.

Systemlord said:
We need the units and ranges please. Going to assume it's nmol/L for testosterone, quite low indeed. Your scoring in the ranges I scored when I felt like I was dying. Most 80 year old have higher levels and younger men need more testosterone, but as we age we need less. Typical testosterone for someone your age is of 600+ ng/dL or 25 nmol/L. Our testosterone peaks in our 30's and begins a slow decline, your decline has started many years too early.

snorgejr · May 5, 2018

I've edited the post with clearer images. Think they should be readable now. The tests posted are all the blood work I've done in my adult life, so I have no numbers beyond this. My doctor has set me on a waiting list so that I "might get an appointment" with an endocrinologist, yet she didn't seem convinced I would get one. The waiting time is appearently 3+ weeks.

CoastWatcher said:
Welcome to Excelmale. Your labs, particularly the first set posted, are very difficult to read. The second set certainly points toward hypogonadism. Did you run FHS and LH (Follicle Stimulating Hormone and Luteinizing Hormone)? That sheds light on the issue of primary or secondary origin. Any thyroid labs beyond TSH?

Systemlord · May 5, 2018

snorgejr said:
As for the units, they were not given. From my own research, the only thing which made sense regarding the T-values were nmol/L, as stated in my original post. Not so sure about the free-T.

A FT measurement at this point will only tell us what we already know, T is dreadfully low. You need to find as many studies as you can to present to your doctor, it might help sway his/her decision to give you TRT. I'll provide some, information is power.

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

https://onlinelibrary.wiley.com/doi/full/10.1111/bju.12970

http://www.auanet.org/guidelines/evaluation-and-management-of-testosterone-deficiency

https://www.excelmale.com/forum/showthread.php?12771&p=88718#post88718

snorgejr · May 5, 2018

I will read them thoroughly. Thanks for the links! What does "FT" stand for?

Systemlord said:
A FT measurement at this point will only tell us what we already know, T is dreadfully low. You need to find as many studies as you can to present to your doctor, it might help sway his/her decision to give you TRT. I'll provide some, information is power.

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

https://onlinelibrary.wiley.com/doi/full/10.1111/bju.12970

http://www.auanet.org/guidelines/evaluation-and-management-of-testosterone-deficiency

https://www.excelmale.com/forum/showthread.php?12771&p=88718#post88718

Systemlord · May 5, 2018

snorgejr said:
I will read them thoroughly. Thanks for the links! What does "FT" stand for?

Free testosterone, it is the free hormone your body is responding to, Total testosterone (8 nmol/L) is the bound SHBG and is unavailable to your body, a reservoir if you will. You could have high Total T, but if your free hormone is low you won't feel well. Many doctors run these test not really knowing what they mean and have virtually no understanding other than the numeral value, these are the doctors that are hesitant to prescribe TRT.

Nelson Vergel · May 5, 2018

I agree with CoastWatcher. You need LH, FSH, Prolactin, TSH, Free T3 and free T4 to find out a little more why your testosterone is low at your age.
Also, have you used anabolic steroids or other drugs in the past? Any head injury? Are you overweight and/or sleep poorly?

Determining why someone has low testosterone takes a comprehensive workup and questionnaire. If you have time, please watch this lecture:

snorgejr · May 5, 2018

Never done anabolics, nor anything remotely close to it. The toughest medicine I've been on were antibiotics. I've never suffered any trauma to either the head or the testies, as far as I'm aware. I'm currently sitting at a BMI of 25.6 (180cm, 83.5kg), with a above average muscle mass due to 7 years of focused excersise. Would guess somewhere between 15 and 20% bodyfat, but I've never tested it. The BMI used to be higher when I was growing up, yet never at the point of obesity.

I watched the webinar earlier this afternoon. It seems to me there is no doubt whatsoever that I'm suffering from a version of hypogonadism, though I'd like to find the root cause. Would you recommend me to wait the 3 weeks and see if I get an appointment with a endocrinologist, or should I get those tests you mentioned done ASAP? I must admit, I'm a little bit concerned with the fact that my doctor didn't even mention the low T-values, just said the tests seemed fine. I've only found a handful of TRT-cases from Norway on the internet, and most of them are very discouraging.

Nelson Vergel said:
I agree with CoastWatcher. You need LH, FSH, Prolactin, TSH, Free T3 and free T4 to find out a little more why your testosterone is low at your age.
Also, have you used anabolic steroids or other drugs in the past? Any head injury? Are you overweight and/or sleep poorly?

Determining why someone has low testosterone takes a comprehensive workup and questionnaire. If you have time, please watch this lecture:

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nagami · May 7, 2018

a very interesting thread

Will Brink · May 7, 2018

snorgejr said:
Hello!

I'm a 25 year old, norwegian male. I've been experiencing close to all the symptoms of low T to a greater or lesser extent for the last 5 years or so. They've been most notable for the past 1-2 years, with a constant increase in severity as time goes by. The most notable symptoms are:

Very low sex-drive (almost non-existent)

I can't remember the last time I had a morning erection

Reduced motivation to do work and excersise

Increasing problems with focusing on things for more than a few minutes at a time (brain fog? Not familiar with the term.)

Generally feeling a bit "under the weather"

I did a non-related blood test a year ago, for which the doctor gave me a "all looks good"-response:
View attachment 5005

Then a second one this april:
View attachment 5006

The units are not given, yet I'm quite sure the Total T ("S-TESTOSTERON" and "S-TESTOS") is measured in nmol/L. The same goes for SHBG. As for the free-T ("FRI TESTOSTERON INDE" and "FTINDEKS") I'm not sure.

I had a consultation with my doctor last week - on my initiative - to attempt to find a solution to the problem. She was very sceptical, to say the least, as I have built up an above average muscle mass after 7 years of strict diet and training. I've never touched any exogenous hormones or anything remotely similar, nor have I taken any medication outside of antibiotics. It seems my T-levels are about that of a 60-70 year old, yet according to my doctor it is "within normal ranges".

My life style is very healthy. I sleep 8+ hours every night, while sticking to the same sleeping schedule throughout the whole week. I eat low processed foods, enough quality fats, barely touch alcohol, I'm not obese, and I'm doing strength focused excersise x5/wk. I've not had any strength increase for about 2 years, despite bringing a lot of focus and energy to the gym. The only apparent thing I'm doing which might be detrimental to my T-levels is studying at the university, thus having periods of stress.

I have a history of being slightly overweight, with a BMI around 30 in the past. I'm in the normal range as of today, yet it has proven impossible to lose fat around my mid-section area. Not sure if this is a symptom of low T or not, but it's very unlikely to be a result of my diet not being on point.

Now to my questions:

Can low T be the reason for my symptoms, and what might the cause be?

Does it seem like TRT might be a possible solution to the problem, despite my young age?

Does anyone have experience with TRT from the public health care in Norway? It seems they are incredibly reluctant to help.

If "no" on question 3: What about the private sector?

Will me getting TRT at such a low age have potential negative effects on my fertility?

Any help would be greatly appreciated. This is really tearing on my quality of life.

May not apply to you, but when was the last time you took a break from the gym? Here's an extreme example of what can happen to a young man overly obsessed with being lean: http://www.brinkzone.com/bodybuilding/natural-t-rebound-a-case-study/

If any of that applies to you, may explain your T levels at your age.

snorgejr · May 8, 2018

Thanks for your reply!

Very interesting article. I do recognize a few of the bullet points, yet I'm no where near as extreme on any of them. Can't really see how my T-levels have been affected to such a degree without those drastic measures. I will nonetheless put some effort into attempting a few of the "Road to Recovery" points made. Perhaps it will have a greater effect than I think.

Will Brink said:
May not apply to you, but when was the last time you took a break from the gym? Here's an extreme example of what can happen to a young man overly obsessed with being lean: http://www.brinkzone.com/bodybuilding/natural-t-rebound-a-case-study/

If any of that applies to you, may explain your T levels at your age.

snorgejr · May 24, 2018

Ok so I did another blood test, of which the results makes me very confused. I still suffer from the same symptoms as I did before, yet they are admittedly a tiny bit less severe than they were earlier this spring. Any tips or opinions as to what my best route of action should be? I'm not sure what more lifestyle changes I could do to improve this further; I'm pretty much applying all the "tips and tricks" I've found to increase my T-levels.

Following are the results (14th of May 2018):

S-TSH: 2.15 (0.24 -3.78) [mlE/L]
S-PROLAKTIN: 115 (61 -314) [mlE/L]
S-FSH: 3.2 [IE/L]
S-LH: 1.1 [IU/L]
S-SHBG: 42 (13 -72) [nmol/L]
P-FERRITIN: 209 (29 -383)
P-KORTISOL: 202 [nmol/L]
B-LEUKOCYTTER: 3.1 (4.1 -9.8)
B-Hemoglobin: 15.4 (13.4 -17.0) [g/dL]
B-Sed rate: 4 (1 - 13) [mm/hour]
P-CRP: <5 (0 -5) [mg/L]
B-NØYTROFILE-%: 55 (39 -73)
B-LYMFOCYTTER-%: 25 (18 -48)
B-MONOCYTTER-%: 17 (5 -13)
B-EOSINOFILE-%: 2 (0 -8)
B-BASOFILE-%: 1 (0 -1)
P-NATRIUM: 141 (137 -145) [mmol/L]
P-KALIUM: 4.0 (3.5 -4.4) [mmol/L]
P-GFR EST /1,73M2: >90
P-KREATININ: 100 (60 -105) [[FONT=&quot]µmol/L][/FONT]
P-KOLESTEROL: 4.7 (2.9 -6.1) [mmol/L]
P-ALAT: 43 (10 -70) [U/L]
P-GT: 25 (10 -80) [U/L]
P-ALBUMIN: 47 (36 -48) [g/L]
P-TRIGLYSERID: 0.67 (0.45 -2.60) [mmol/L]
P-HDL-KOLESTEROL: 1.71 (0.80 -2.10) [mmol/L]
P-LDL-KOLESTEROL: 2.5 (1.3 -4.7) [mmol/L]
S-FOLAT: 23 (9 - 36)
S-Free T4: 13.9 (11.6 -19.1) [pmol/L]
B-HBA1C: 5.1 (4.7 -5.8) [%]
S-VIT D (25-OH- KALSIDIOL): 149 (35 -117) [nmol/L]
S-TESTOSTERON: 14.9 (6.73 - 31.90) [nmol/L]

I was concerned my cortisol might be very high, yet this seems to be in the lower range of the normal range. Seems my LH might be a bit low though?

snorgejr · May 28, 2018

These are the units used in Norway. I think this would be the ones in use in USA:

- Total-T: 430 ng/dL
- Free-T: 7.62 ng/dL (1.77%)
- Bioavailable-T: 179 ng/dL (41.5%)

Still very confused as to how I should interpret the results though. Any suggestions?

Systemlord · May 28, 2018

snorgejr said:
These are the units used in Norway. I think this would be the ones in use in USA:

- Total-T: 430 ng/dL
- Free-T: 7.62 ng/dL (1.77%)
- Bioavailable-T: 179 ng/dL (41.5%)

Still very confused as to how I should interpret the results though. Any suggestions?

Your Free T is near the bottom of the range and Total T is below midrange, SHBG is higher than midrange which doesn't help. Most men your age are topping out in the 800 ranges, so you have about half the testosterone of other healthy men your age. This is how you should interpret your results.

snorgejr · May 28, 2018

What would be a smart course of action to determine what the cause might be?

snorgejr · Jun 19, 2018

So I decided to go to a private endocrinologist to get this sorted out. This led to yet another blood test, which gave the following results:

He was a bit clueless as to the cause of my low T, and the low LH especially. He ruled out the possibility of it being a adenoma on the pituitary gland, due to the relatively low prolactin. He then went on to offer me the option to start on testogel, which is the most common TRT in Norway. I do not want to start on TRT, so we decided I would do a MR scan of my head, nonetheless. Does anyone have an opinion as to what else could be the cause of my problems, in case the MR doesn't show anything? And does anyone have experience with testogel, especially in lower aged individuals? It would be great if I could sort this out without committing to a life long TRT...