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31, low testosterone
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31, low testosterone

Hi all,

I am looking for advice. I am 32. At a recent annual physical, I asked my dr. to check my testosterone level as part of my blood work, mostly out of curiosity, but also because I have trouble building muscle mass and strength despite putting in my time at the gym. Other than that, I have no other common low t symptoms. I have a great sex drive, no problem getting an erection, plenty of energy, have had 2 children recently (so am fertile),in good physical shape etc. My first test came back at 168. He did 1 more and it came back at 160. I was referred to an endo, who did a more detailed work up and came back with the following:

TESTOSTERONE, FREE AND - 01/24/13
Results:
- TESTOSTERONE, TOTAL, LC/MS/MS: 180 Low
- FREE TESTOSTERONE: 43.7
THYROID STIMULATING HORMONE (TSH) - 01/24/13
Result:
- THYROID STIMULATING HORMONE: 2.6 Normal
SEX HORMONE BINDING GLOBULIN - 01/24/13
Result:
- SEX HORMONE BINDING GLOBULIN: 16
FOLLICLE-STIMULATING HORMONE (FSH) - 01/24/13
Result:
- FSH, SERUM: 1.9 Normal
PROLACTIN - 01/24/13
Result:
- PROLACTIN: 7 Normal
RENAL FUNCTION PANEL - 01/24/13
Results:
- SODIUM: 143 Normal
- POTASSIUM: 4.6 Normal
- CHLORIDE: 100 Normal
- CARBON DIOXIDE: 29 Normal
- GLUCOSE: 103 High
- BUN: 20 Normal
- CREATININE: 1.1 Normal
- BUN/CREATININE RATIO: 18 Normal
- GFR ESTIMATED (CKD-EPI): 89 Normal
- CALCIUM: 10.4 Normal
- PHOSPHORUS: 3.5 Normal
- ALBUMIN: 5.4 High
LUTEINIZING HORMONE (LH) - 01/24/13
Result:
- LUTEINIZING HORMONE SERUM: 1.6 Normal
T4 FREE - 01/24/13
Result:
- T4 FREE: 1.37 Normal

The endo also sent me for an MRI, which came back with nothing. He said that he has run out of options for finding the root cause and that I just have low t. He prescribed me androgel, which I started last week. I am on no other meds or supplements.

My questions are:
Any ideas what could be causing this?
If I have no major symptoms, do I need to be on androgel?
Any other tests I should have done?
3 Comments
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Avatar_dr_f_tn
HI,
How are you? Low testosterone levels may be caused by a variety of  factors such as injury to the testicles, possible testicular cancer, hormonal disorders, infection, chronic liver or kidney disease, diabetes, obesity, medication side effect and even genetic conditions. Treatment is sometimes considered if  symptoms are present and to prevent drops in bone density. When fertility is not an issue, the ideal testosterone delivery method is a daily gel or patch. Because they are applied on a regular and frequent basis, these keep a man's testosterone at a steady level and prevents symptoms. Discuss this with your attending physician for clarifications also and to ease any doubts. Take care and best regards.
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Avatar_m_tn
Dr. Santos,

Thank you very much for your reply.  What if fertility is an issue?

Thanks,

Scott
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Avatar_n_tn
Hi,
   As a person interested in the subject, I would add a few points for your consideration:
From your test results, your total T is consistently below 200, which qualifies you for treatment, but you do not have any any symptoms, including sperm production. So, the first thing I would advise you is to go for T replacement only after detailed diagnosis and additional consultations.
Your report also says your free T is 43.7, I suppose it is ng/dl ? If so, you have an enviable free T level which many others with huge total T counts can not have. The reference level from Mayo clinic is 9 to 30 ng/dl.And that explains why you are symptom free.
However, this high level of free T has its own possible issues.
Generally, a high level of free T suggests some possible issues with liver or pancreas like a fatty liver or a sustained high level of insulin, both individually causes a reduction in SHBG levels produced by the liver. In your case an SHBG of 16 is in the lower range of 12 to 54 nmol/L, though within range.

In this context, I also find that your glucose level is high at 104, which could suggest a higher average level  of insulin presence.
I would therefore suggest you to do further testing of both your liver functions and glucose levels. If you reduce your glucose levels, it is likely that your SHBG would rise and your total T would go up. At your age it could even be a pre-diabetic condition.

In case the tests shows fatty liver, suitable treatment would once again improve T total count. If you are alcoholic, keep away from it. If your diet contains more carbohydrate reduce it and substitute it with more vegetables and fruits.Zinc is useful for both alcoholic  and non alcoholic fatty livers and it also is well known to push but T counts especially when it is low. Do regular exercise, but do not do over exercising, as overexercising is known to reduce T levels.

How is your testicular health, apparently is ok, but nevertheless, consistent low could shrink them.

Take care and postpone at least temporarily the decision for T supplementation as in your case you do not any symptoms of low T and your pituitary-testes combo seems to be doing its job. Supplementation in such cases can make things worse.

Solace
  


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