26 year old male...with hormonal issues

[gifted26]

Hello,

I'm 26 years old and I've long suspected that i have some issues with my hormones.. here are the reasons:
- slight gynecomastia from puberty
- so-so libido
- impossible to gain muscle
- extremely easy to gain fat (mainly stomach, hips)
- i've got cellulite, stretch marks on legs/hips
- anxiety
- very tired in afternoon, despite very good sleep.. energy just fades
- i just feel weird and old.. can't explain
..and i could go on and on..

I've been fat as a child and till bout 9th grade, when I really started with a lot of exercise and seriously cleaned out my diet (which was never bad at all!). Everyone around me has always been skinny. I've really been working out a lot and eating properly. In this time I also became a certified personal trainer, finished a degree in nutrition and sports.
At the moment I'm no my optimal fitness level, with still lots of fat, mainly hips,chest (though that is gyno - also verified by an endo) and stomach.

Now to my blood tests:
After my first visit ot the doctor, he put me on minor blood tests for:
- S-Testosterone :  3,75 ng/ml (3,0-8,0)
- TSH : once 2,05 mUI/L and another time 1,54 mUI/L
- S-Glucose: 4,6 nmol/L
  He said I'm perfectly fine. I argued that my T levels are quite loq for a 26 year old and that I'd like another checkup with an endo.. so he sent me there.

Blood work with endo:
   - S- Prolactin : average 14,7 ug/L --- tested three times - ne reference ranges given
   - S-Albumin  : 47 g/L
   - S-Test : 16,8 nmmol/L  (5,5-30,4)
   - LH  : 1,9 mUI/mL
   - FSH: 2,7 mUI/mL
   - SHBG : 33,6 nmol/L
   - TSH : 1,44 uU/ml
   - Cortisol : 763 nmol/L
   - Cortisol 30 min after ACHT : 886 nmol/L
   - he also tested for some other stuff.. only thing that's standing out is low potassium levels. Though i monitored my diet specially for that all the time. Making sure I got more then enough.. no idea how its low.

This endo concluded that I'm perfectly fine. He even said Optimal. What I see is low'ish T, low LH and FSH, high cortisol and somewhat high prolactin. All tests were done at around 8am.

Was a bit worried about this results and went to another endo for a second opinion..He noticed the high cortisol, for other he said it's all fine. So he put me on some other blood tests:
  - S-PSA : 0,48 µg/L
  - S-DHEA-S  :  6,7µmol/L  (3,6 - 13)
  - S-Testosterone  :  17,2 nmol/L  (8,8-30,6)
  - S-Testosterone Free  :  32,1 pmol/L  (31 - 94)
  - Prolactin :  13 µg/L
  - Estradiol : 0,16 nmol/L  (0 - 0,21)
  - FSH  : 2,07 E/L  (0,7 - 11)
  - LH: 2,32 E/L   (0,8 - 7,6)
  - TSH : 1,9 mE/L
He put me on DXA (L1-L4) scan that diagnosed me with Osteopenia (T-SCORE -1,5, -0,8, -0,5, -1,5).
He DID NOT put me on cortisol/ACHT tests, which is rather strange. Potassium was again low, simply no idea why, since previous blood test i even added some potassium supplements and even more spinach etc. I'm getting like 300%+ rda of it.
His conclusion was that I'm perfectly fine. Only thing he said that I can get the gynecomastia surgically removed.
Ok.. even gyno is kind of proof that something isn't right. On this tests I see results that are ok for a 60 year old guy, but not with someone who's 26 years old (T/E ratio is basically upside down). From the look of it I have secondary hypogonadism.. i guess I'll have to wait a few years to fall below the reference values and get help then! Though some values already are over/below.

Can anyone comment on these results? Thank you very much!
  

[LowCortisol]

I am not surprised that you cannot find a good endo in your country. Very few places have good endos, that is an endo who knows more than diabetes.
If you travel to say Germany or the Netherlands in the near future then there you will find a good one. I traveled from Australia to the USA for surgery a few years ago because I had no confidence in the local surgeons I found

[gifted26]

I don't consume any soy products at all.
Finding an endo that knows about male hormones etc. is basically impossible I see. I though that's only a problem in my country, but I see that men from everywhere have the same problem.
I was at two endos already.. first one said men don't have estrogen as women do, so he won't test for it. He loses any credibility right there.
Second one though cortisol is unimportant, disregarded all the symptoms and said I'm allright. He did notice the gyno though, hah.

I'll really have to think about my options now..

[LowCortisol]

I am not an expert in estrogen but wonder if you consume soy products eg soy milk or tofu. If this is the case then please stop it. Do you snack between meals?

If an endo doesn't believe you need a 5pm cortisol test then find a better endo. You will need to work with a good endo for some time so you should try to find a good one. Have you tried a nearby hospital that has a well regarded endo unit?

[gifted26]

Hello,

Thanks for your answer. That's precisely what I told my second endo.. that he should get me checked for cortisol levels in the morning and afternoon, but he just dismissed me.
Regarding carbohydrates, yes I've done that gradually and it somewhat helped, but not much. ATM i'm on ketogenic diet (so very low carb), for about 3 years... my hormone levels got better and also in general I feel a bit better better.
Regarding libido, yes of course T levels aren't the only important thing, but generally Testosterone/Estrogen ratio is of importance. Too much or too little estrogen relative to testosterone can cause low libido. My E is in upper part of the reference range, while T is in lower part - i think this is the main issue. Maybe my libido and other symptoms would be perfectly fine if it was also in lower range. I'm not overweight, so that's not the reason for this (18% body fat... where fat is mainly on mentioned places).

[LowCortisol]

I have only three comments:

1. Cortisol should be checked at 8am and 5pm ON THE SAME DAY. If you only test cortisol at 8am then the result is of no value.

If you are very tired in the afternoon, then perhaps your 5pm cortisol level is very low. Another good reason to check both morning and afternoon levels ON THE SAME DAY.

2. You comment on low libido and low testosterone. These are NOT the same thing. My testosterone level for example has for a LONG time being well within the normal range but my libido (ie sexual drive) has been and remains low.  

3. If you want to lose weight cut down on the carbohydrates you eat. limit carbohydrates to two meals per day.