What additional bloodwork do I need? Low test @ age 28
Just got my testosterone levels back from my doctor and although he said they were within "normal" range, I feel they are very low for my age.
I'm 28 and the total test was 342 (range 250 - 1100) and free test 1.6% (1.1 - 2.8).
Does anyone else feel that this is abnormal? I have been tired and run down for months now, have no libido and have lost strength in the gym. I have a terrible time staying awake and motivated after eating dinner at 5pm.
Diet is in check, exercise is in check but I just never seem to feel good.
Any suggestions for additional tests? I'm going back on December 5th to discuss why I don't think 342 is normal for a 28 yr old. I was thinking LH, FSH and E2 for bloodwork. Possibly ask for low dose of HCG, to see how I respond to that.
Any advice is greatly appreciated, I have found hope in these boards knowing that others are going thru similar problems.
Re: What additional bloodwork do I need? Low test @ age 28
VP, This is how I felt about 2 years ago when my test came back around 250. Tired all the time, loss of strength, noctural erections seldom if ever and sarted to get ED. Replacing the T helped alot. Not sure how it effects sperm production, that is a good queston for the DR. CD
Re: What additional bloodwork do I need? Low test @ age 28
virginpose, you are thinking on right lines when you say AI could help. starting TRT in a rush and at 28 is not a good idea.
i have started AI last week. (total T 482, free very low, Lh and fsh near low range, e2 high 54) not much effect on libido yet but ED is gone (may be placebo effect)
you should also check progesterone , shbg and DHT.
Re: What additional bloodwork do I need? Low test @ age 28
I agree to check E2, LH, FSH, DHT, SHBG, Progesterone and would add TSH and total estrogen to the list and a check for hemochromatosis (iron, ferritin, TIBC, saturation %).
I also agree at your age you should not be too quick to start TRT. First you need to at least try to determine why your T is low, and 350 is definitely low for your age regardless of what your doctor says. This is confirmed by the fact you have low T symptoms.....fatigue, no morning erections, etc etc...
LH and FSH check along with a total T check on the same blood draw would tell you if you are secondary or primary. Primary means LH is high but testicles cant make enough T, secondary means LH is low despite the fact T is low. Most likely at your age its secondary. Then try to find out why you have secondary. Could be estrogen is too high or E2, could be hemochromatosis, could be pituitary adenoma (requires MRI to diagnose), could be hypothyroidism, could be low on vitamin D, etc etc....
Only then try replacement of some type. Your testicles likely work fine so HCG is your best bet to start. You can inject yourself with a fine insulin needle despite what your doctor may think. Studies have shown this to work fine but HCG is only approved by FDA for IM injection. Do not do more than 500 iu per day or you risk desensitizing the leydig cells in the testicles that make T and then you will be primary. A large initial dose is ok but dont do more than 500 iu on a regular basis.
I'm sorry you are having this trouble at such a young age, mine started around age 40. I have been down this road and can tell you that you are way smarter than I was by looking into this before you start treatment. Keep asking questions and be willing to change doctors if necessary. Most doctors are not very good at this. Read the book The Testosterone Syndrome by Eugene Shippen.
Re: What additional bloodwork do I need? Low test @ age 28
I should add that if your E2 or total estrogen is high the AI idea you have may do the trick. But it's not likely a short course of it. It may be for quite a while unless/until you can figure out why your estrogen is too high and resolve it.
Re: What additional bloodwork do I need? Low test @ age 28
Definitely check your thyroid because it can cause all those symptoms as well.
You can also test for prolactin, DHEAS and growth hormone, all of which can be related to lower function and fatigue.
Re: What additional bloodwork do I need? Low test @ age 28
Thanks for the advice everyone. I definitely want to know 'why' before starting any treatments. I think I have enough info know to take to my Dr. and point him in the right direction for treatment. If not, I will find another more opened minded doc.
I just want to feel like I'm living my life again and not held back.
Re: What additional bloodwork do I need? Low test @ age 28
Did not have a good visit with Dr. He was in the room all of 1 minute and already had a 3 month script ready for Testim. My insurance will not cover it and I cannot afford the $225 per month fee. He didn't want to see me again for 3 months, and said it would not effect my fertility. Needless to say I need to find a new doctor.
Has anyone tried the compounding pharmacies?
How about Canadian pharmacies?
Re: What additional bloodwork do I need? Low test @ age 28
Did you tell him you can not afford it? What a bone head. I have not used the compounded T creams but am told by my doctor they only cost about $20 a month. He is patently wrong that it will not effect fertility. If I were in your shoes with no insurance I would write him a letter and tell him you have no intention of paying for that visit. Tell him he is giving you false information and should consider himself lucky you dont make a complaint about him to the state health board. But, I assume they probably made you pay while you were there.
I feel bad for you. It's hard enough to find someone who can do this without also having to worry about the cost with no insurance. My guess is even Canadian pharmacies will require an Rx.
Re: What additional bloodwork do I need? Low test @ age 28
Another update to my situation.
I have now filled my Rx with a compounding pharmacy. Before I begin though, I'm having my own lab work done [removed] 50% off from what I pay at the Dr, and the work is done at the exact same ******* location. I will be testing E2, LH, FSH, Free and total test, FTI, prolactin, T3, T4, TSH. These will give me a solid baseline for info before I begin the compounded cream.
I will also be using DIM & TMG for a healthy AI combo. I will have another round of labs done at the 4-6 week point, depending on how I am feeling.
Wish me luck.
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Re: What additional bloodwork do I need? Low test @ age 28
Wow you sound like a pro. You must have done your homeowork to know about DIM and TMG. Good for you for taking control of this. Best of luck and please post how its working out.
Re: What additional bloodwork do I need? Low test @ age 28
Try to get the testosterone into the high 500s or low 600s.
Watch the E2, if it gets higher & the DIM + TMG do not lower it try 1/2 Arimidex tablet a couple of time a week.
When my E2 gets too high I get the heavy night sweats.
I started on the patch, AG, compounded, & now do 60mg testosterone cyp per injection twice a week. On those days I take the Arimidex.
I also do the DIM & TMG on the other days.
My body likes to make E2, even when my "T" is at the bottom or below the range. Before I started doing "T" the "T" level was in the low 100s & the E2 was twice the range. I have Klinefelters Syndrome Mosaic.
For future children do low dose, 500iu, HCG injections 2 or 3 times a week.
The "T" supplements will shutdown normal testosterone & sperm production. The HCG usually counters that & prevents shutdown & shrinkage.
Re: What additional bloodwork do I need? Low test @ age 28
FSH is a better indicator than LH of having secondary hypogonadism. Secondary is where LH is low or normal while T is low. FSH is a better indicator because it has a longer half life in the blood than LH. LH comes and goes in pulses from the pituitary so one test showing it is low normal is not necessarily enough but LH being low or normal while FSH is also at low end of normal indicates likely secondary hypogonadsism. That said, your total T level is not that low. It is low but most doctors probably would not even treat it except that you are having symptoms. You Estradiol level is also not too high however the T/Estradiol ratio is a little low mostly because your T level is on the low side.
If I were in your shoes I would test for total estrogen and vitamin D deficiency. Both can also cause secondary. If you are ok on both then just to cover bases I would get an MRI of the pituitary to rule out a pituitary adenoma and check blood iron levels (iron, ferritin, TIBC, saturation%) to rule out hemochrmoatosis.
For treatment I would first try HCG only considering your age. Your testicles likely work just fine. In fact considering your LH is only around 4 I think they work great. HCG will get your testicles to produce all the T you need and keep them active and keep you fertile and making sperm too. Do not take more than 500 iu per day of HCG or you will risk desensitizing your lyedig cells and then they wont respond to HCG or LH. Many doctors do not now this. You will probably have to self inject but dont worry its painless and easy. I can give you instructions if you get to that point. I mean painless too....if you have a fear of needles you will quickly overcome that and the benefits will make you feel great. You will need to keep an eye on estradiol while you treat this keeping it below 35 pg/mL. To start out I would try 300 iu of HCG three times a week and go from there adjusting dose up or down depending on T levels. Also get your SHBG tested. You can use this to determine a target total T level. If you are on testim now it will shut down your testciles, make them atrophy (shrink) and stop producing sperm. Dont take this litely. It can be irreversible after enough time. Mine appears to be irreversible after about 4 years on androgel.
Re: What additional bloodwork do I need? Low test @ age 28
Thanks for the replies JinL and Hayfarmer.
I will definitely get some HCG in the near future. Whether that means my Dr. wises up or I go black market for it. I am already sensing testicle shrinkage after 2 weeks on the compounded test.
I will also being going for another round of tests to check out iron, total E, SHBG, vitamin D, and a few others.
Looking into to more natural supplements as well. Nettle root and Saw Palmetto and going to be added soon.
Again, thanks for the support and I will keep you all posted with this thread.
Re: What additional bloodwork do I need? Low test @ age 28
I do 100 to 125mg per week of Tetsosterone cyp. & 500IU of HCG at least 2 time a week.
I think the DIMM is licensed by Bio-Response inc for manufacture. I use the DIMM + by Natures Way.
Most doctors & endos know little about hormones. I had the first endo tell me I did not need to have my Estradiol E2 tested since it was a female hormone. He asked me what E2 was. I told him it was Estradiol, an estrogen.
He told me to not believe everything I read on the internet.
I changed doctors & the new one. a DO, tested me & the E2 was twice the high limit & the testosterone was 1/2 the lower limit.
Get & keep a complete copy of your tests for your personal records. Many doctors to not want to do this, but here in the states it is required by US law.
After I got my E2 down & the T up to a "T:E2" ratio to 20:1, I felt much better.
Re: What additional bloodwork do I need? Low test @ age 28
Adambomb, you must find another doctor. You are too young to be on T replacement without HCG. HCG would have and still may get your testicles working again and keep you fertile. If I were in your shoes I would seriously consider legal action against the doctor that put you on T replacement and did not inform you of the loss of fertility and never mentioned HCG as an option. If they don't know what they are doing it is their duty to refer you to someone who does.
Do this quickly, the longer you wait the more likely the atrophy to your testicles will be permanent. HCG stands for human chorionic gonadotropin. Your testicles will liley get bigger also after you are on it for a while. I'm sure you have questions about HCG, please post them and I'll answer. This makes me mad a doctor would do this to you. Same thing happened to me.
As for DIM, I used Natures Way and it did nothing for me. I found another brand worked better for me at least....Indolplex with DIM by PhytoPharmica.
By the way, if you have empty sella syndrome you also need to monitor your TSH level. All hormones coming from the pituitary may eventually cease.
