Low testosterone in 19year old male

My 19 yr. old son is an athlete and college student.  He is 6' 5" and weighs 250 lbs.  He is a sophmore this year.  He gained the freshman 10-15-20-30-40+ pounds!  Besides excessive weight gain (specifically waistline) with considerable stretch marks, stretch marks also on thighs and underarms, other symptoms are: mood swings, irritability, mild depression, lack of energy, lack of ambition, inability to concentrate, timidity, passive, general tiredness, inability to cope, lack of assertiveness, breast enlargement, puffy appearance in face and neck  

He plays JV basketball in college and this summer he worked with a personal weight trainer twice a week, played basketball 2 - 4 times a week, and has done a cardio workout routine 3 - 5 times a week.  He has changed his eating habits considerably.  He has eliminated soft drinks almost completely, cut way back on fast food, making healthier choices.

I took him to our family doctor and he has him on an anti-depressant.  I believe the depression is a symptom of something else.  I convinced the dr. to test his testosterone level (he said he was too young for that to be a factor).
His Total T is 298 (reference range 280 - 800).  He said that was normal.  

I then took him to an endo.  He also said this level was ok, but ran other blood work. (he said he is growing kind of late).
His Free is 5.9 (reference range 8.8 - 27.0)
Other labs results he said were fine:  Cortisol, IGF1, ACTH, - CBC (with monocyte 3.1 ref.range 4.0 - 13.0), Thyroid: TSH -Free T3 - Free T4 - T4 Total  Lutein Horm 3.3 ref. range 1.7 - 8.6) - Human GH <0.05 ref. range 0.00 - 1.00)

In addition, my son was late going through puberty.  I am fairly comfortable after getting the lab results and having him examined by an endo, that his low T is not caused by some bigger health problem.  However, I strongly feel his hormones are out of balance.  I know my son and he is not functioning at an optimal level in any area:  scholastically, athletically, socially, and physical appearance (in spite of his efforts).  

There is a lot of information out there about low T and aging AND marketing for T suplements for those who want to increase their ability to build muscle or improve their sexual performance.  I don't want to play around with his hormones.  I want someone who knows what they are doing BUT as it turns out I am having difficulty finding ANYONE who is on board with the importance of hormonal balance with regard to general good physical and mental health.  

Can anyone offer any suggestions as to how I can get my son some help?  I am concerned about the challenges he faces with regard to his scholastics and sports as he is about to go back to school.  

Why is no one in the medical profession concerned?

[solace21]

Hi,
   I am writing this note based on whatever little info I have on the subject. The answer to your question apparantly is there in your question itself. Since you told that he is having late puberty, it is evident that he is in the growth spurt stage and during this stage most of the testosterone produced is getting converted into estrogen which helps the growth process. I suppose this the reason for his reduced testosterone in the body and you need not worry about it. After his pubertal growth is completed, his testo. level should get back to normal.
I suppose, he does not take any steroids for his athletic gains. You should take special care of his balanced food intake at this stage, may be with the help of a dietitian and wait for him to complete his puberty. I personally would advise you to concentrate on his daily Zinc requirement by giving him zinc rich  nonveg. food, as it helps in overall male sexual development.
Solace

[frustratedmom58]

Thank you for your response.  He WAS slow in his start of puberty.  Anatomy wise, hair growth, deep voice, etc. are all fine.  He has just gotten bigger and gained more height kind of late.  Don't know if he is going to get taller yet.  Maybe.  Just because he is getting bigger doesn't mean he hasn't gone through puberty, does it?

[solace21]

Hi,
  "Just because he is getting bigger doesn't mean he hasn't gone through puberty, does it?"
Yes that is what I would expect. There are are defenitive stgaes in puberty and late bloomers also will have to go through it.Gaining height is within the period of puberty. And also estrogen is the common hormone in boys and girls that is required for growth, in boys, it is produced by conversion of testosterone, so, I would expect it to be low in boys during growth period. If you have any contra information, please let me know. You could as well check this with your endo?. For various stages of puberty, you may refer the following link:
http://en.wikipedia.org/wiki/Puberty

Regards,
Solace

[frustratedmom58]

Hi,

I would never have guessed he is still going through puberty!

You were correct in your assumption that he is not taking steroids.  
Would the increase in estrogen explain the breast enlargement?  "You would expect his T to be low during the growth period."   Do you suppose this is an indication that he is going to get taller?  I will start him on a zinc supplement.  He is extremely embarrassed by his weight gain and stretch marks at his waist - so much so, he will not go to open gym as they play shirts and skins.  Does puberty affect the metabolism?  With as active as he has been all summer, he has not lost any weight.

It's tough enough for parents to get their kids through junior high and high school as they go through puberty.  But college?!  We have a lot at stake financially.
I am afraid it might be to much to expect from him.  I have been desperately trying to get some help for him.  Now, thanks to you, I am relieved to have an answer to what is going on.  It makes sense now that you have explained it.  My husband and I are both comfortable with your assessment.  Why one of the four doctors we have consulted could not have figured this out, I have no idea.

However, besides zinc and a balanced diet, all we can do is wait?
Testo supplements of any kind would not be advisable?  He is passive with regard to studies and he lacks aggressivness on the court.   He just turned 19 in May, do you think it is likely he will complete puberty before he is 20?

Thank you,
frustratedmom58

[solace21]

Hi,
" I would never have guessed he is still going through puberty! "
You can actually get it checked by the Endo. He will be able to assess at what stage of puberty he is. It will be a good idea to ensure that all his pubertal growth is going on in order. He can also take a wrist/elbow  X-ray and find out his bone age. That will tell you exactly whether he is going to grow more or not.

" Would the increase in estrogen explain the breast enlargement?  "
Yes, in fact high estrogen is the real problem. In the hormone testing, it ia also better to check his estrogen level and check doctor's opinion on that. His total testosterone is within limits, but his free testosterone is outside, and it could indicate higher estrogen levels.

" Does puberty affect the metabolism?"
During the initial growth spurt there will be increased metabolism. In normal cases, testosterone subsequently converts the fat into muscles and male body appearance occurs within one year of Peak Height Velocity. So, you may need to wait some time for him to complete his puberty, if the tests show that he is still going through his puberty. I suppose his late puberty may be due to his athletic activities, or due to a family history, in which case, all his present problems should go away once he completes his growth. I may also think that part of his problem has come due to fast food.
As far as possible  avoid any form of supplements unless recommended by a doctor. If he is a nonveg., even zinc rich food should be considered instead of supplement, as many zinc  supplements come along with added other vitamins, and excess of those might do harm. In case you want to take the supplement route, please check up with your doctor, regarding dosage and duration.
Incase you can take him to Endos working in research oriented hospitals, instead of smaller clinics, you may get better guidance. In any case please continue the follow up testing once in every six months till his problem is completely cured.

Solace  

  

[frustratedmom58]

You are a bundle of information!  Are you a doctor?  We have an appointment with an endo in Chicago (Univ. of Chicago). Thank you for all the information.  I appreciate knowing some things to ask the doctor to check.  I will post what we find out.
Thank you so much!
Less frustratedmom58

[sage009]

Try to google hypogonadism which can have a number of causes.  To cover all bases make sure testicular cancer is ruled out also.  

[solace21]

To  sage009,
          I suppose these need not be of worry in this case, as the boy has had all his pubertal development in place (though little delayed), including a very good growth spurt, without any medical intervention, which clearly suggests that  it is a typical case of Constitutional Delay.        If all  his  fat  related problems are due to pubertal estrogen, they  should also get resolved in due couse with out any medicines. However, if he has excess estrogen (which can also lower the testosterone levels), it may be due to fast food intake combined with irregular athletic exercises.    I suppose, in this case, by doing optimal continued exercises, along with a controlled food intake, he must be able to reduce the fat in his body, as well as increase the testosterone levels. Afterall, he is very young and athletic and  his body would be flexible enough to adapt inself, given the right environmnt .  

To (less)frustrstedmom,
         As I have already  mentioned earlier, I am not a Doctor, I am learning these just out of interest, so that I may be able to at least understand the hi tech  medical words the doctors use nowadays.
By the way, does he have an irregular pattern of exercising? If so, he should follow an optimal regular workout (which Iam sure he would know as an athlet), as it is said will help to boost testosterone. It is said that excessive workout reduces testosterone levels, but then if it were regular, fat building should not have taken place. However, if the excess fat is due to his pubertal growth, it should go away of itsown in due course, but he has to continue regular, optimal workout supported by proper dietary control. I suppose that is the reason why  doctors who examined him were cool over his development pattern. On the home remedy side, you may give him one glass of lemon juice mixed with about three fouth table spoon of  honey in the morning, as lemon contains Vitamin C and honey is a good fat reducer. Rockbee honey got from some small size honey bees having hives in rocks are supposed to have good medicinal value, but may not be commercially available. If he is taking antidepressants, I would suggest  to take a second opinion on that. You should mentally prepare him to face challanges in life and face failures with a positive attitude and offer  unconditional support  from your side. I am sure his depressive moods may be the direct outcome of his perception of his delayed body growth, and here,  your reassurance and support will be of great value. As a Mom, you should also make sure that your worries are not passed on to him. Afterall, I feel there is no reason for worry in this case.

One more thing, I wanted to remind you is while doing hormone tests next time, ensure to test his thyroid hormone levels T3, T4 and TSH,  if it is already not tested and found to be normal. Though you have mentioned these parameters in the report, no values were shown. Fast foods are implicated in thyroid disorders, and hypothyroidism can show up as weight gain, fatigue, depression etc.

With best wishes to see you as a happymom soon,
Solace          

[frustratedmom58]

Hi solace,
I just saw your post.  A lot of things to think about.  Do you think we should be taking him to a pediatric endochrinologist?  Probably not because he is 19.  We have almost a month before his appointment.  Wish I could get him in somewhere sooner.  His thyroid levels were normal.  We have always tred to be as reassuring, supportive and encouraging as we can.  And, I take great care in presenting a positive, happymom so he does not see the worried, frustratedmom.  
Thank you for all the information, encouragment, and best wishes.  I will keep you posted.
happymom soon :)

[solace21]

Hi,
"  Do you think we should be taking him to a pediatric endochrinologist? "
  That is what I would think, since it is a puberty related issue, even if his age is outside of normal pediatrics limit. If his thyroid is also ok , I personally feel that he should be ok. One month waiting may not be a problem in this case, if you can get an appointment with an experienced doctor in a good hospital.
Solace

[frustratedmom58]

Hi Solace,

I am back to frustratedmom!  Saw the endo in Chicago today.  He says his T levels are fine!  He is not still in Puberty.  Thyroid Levels are fine.  He is doing a saliva test for Cortisol levels and a blood test for Prolactin.  He does not think he has an endo problem and does not expect to find anything abnormal. He is not on board with balanced hormonal health.  He doesn't even believe low T is a problem in older men.
He said he absolutely does NOT advise T supplements.  He was pretty much condescending.  Not sure what to do next.  
frustratedmom58

[solace21]

Hi,
    Thank you so much for posting the doctor's comments in your son's case. Actually, I feel you should be happy to have heard a second opinion from an expert doctor that nothing is wrong with your son. It is true that testosterone replacement should not be considered at all for his age, especially, when his  hypothalamus-pituitary- testes system  appears to be working properly. The total testo level count may be low, but not that low to worry about, and both free testo and LH are proportionately low, which means that the negative feed back system is working fine. Under such situation, if you try to supply additional testo, the body will start producing still lesser testo to compensate for the addition. It can inturn affect the functioning of testes.
What I wonder is why the Endo has not bothered about testing of estrogen, or, was it measured earlier and found within range? Have you not told the doctor about increasing weight and associated problems what you have described in your first post?, and if so, what was his response? May be weight reduction itself may increase the total testo, as it will reduce the estrogen levels and inturn body will start producing more testo.
Did the doctor make any suggestion towards weight reduction? I hope, by testing cortisol and adrenalin, he is trying to assess if the boy's lack of competitiveness is due to some problem with the adrenal glands. By the way, did you get the test results for these and if yes, what was the doctor's remarks on the results? In any case, I feel that the Endo will be handling many such cases on a daily basis and if he says there is no problem, you could as well go with his opinion and stop worrying.
By the way, MEDHELP site has also got ' ASK A DOCTOR ' FORUMS and there you will find  ' Pediatric Endocrinology Forum ' . If you ask the same question over there, the related doctor will reply you and if you are still worried, may be you can post your questions there.
Now I only feel that by proper diet control and moderate exercise, it should be possible to reduce the weight and inturn, increase the testo counts. In any case, I feel it is high time that you removed the adjective ' frustrated '  from your name
Solace