Low T?

[k7979]

Hi, I'm new here and this is my first post. I'm a 22 year old male, I had a blood panel done in August of 2012 done due to my suspicion of low testosterone levels. I then was called and informed that everything was normal, but referred to a urologist, which due to my own negligence I did not go to see (I will be having an appointment asap). However after seeing the doctor recently I was given the exact results of the testosterone test, they were as follows:

Result Reference range
Total testosterone 405 pg/mL 405 pg/mL 0.29-3.18
Testosterone Free, Serum 16.32 ng/dL 6-77
Testosterone Percentage Free 0.40

The reference ranges for these seemed to me to be wildly incorrect, so I talked to the nurse who also found them strange so hopefully I will be hearing back on that soon. But while the total measurement falls within reference ranges I have found online (around 250-1100), the free number does not (35-155). And the percentage free is very low.

As far as symptoms go, I had never really attributed all of these at first to the possibility of low testosterone, but after doing some research I was astounded to find that many could be caused by low T. But these are what I am experiencing:

Inpotence

Low sex drive

Balding (on the top of my head)

Slow muscle gains (I work a very physically demanding job, normally I doubt I could make any gains from a gym)

Low confidence/general apathy/on and off depression

Tiredness/fogginess/poor memory I am prescribed adderall for adhd, which is the only thing that allows me to think clearly, stay productive, and talk like a human being, without it I can sometimes have trouble even stringing sentences together

When this test was done I was far more overweight then I am now, (lost 50-70 pounds this year), which I attribute to making massive cuts in my diet and my job. However symptoms have not changed from this. Also I have no problems growing hair (except for the top of my head) facial hair grows at a decent rate, and I have hair pretty much everywhere else. As far as I know I have no other real health problems besides those mentioned.

Overall I am excited at the prospect of a solution to this, if indeed I have low testosterone then treatment may be able to drastically improve my everyday life.
I'd like to hear your thoughts and experiences on this.
Thanks!

[Justin]

Reference ranges are typically not the best way to gauge things. In those cases, they take all men of all ages and more or less lump an average range together. They really don't tell us much. However, widely accepted in TRT circles is the standard optimal ranges of 700-1100 ng/dl for total testosterone and 20-30 pg/ml for free testosterone. Equally important, these numbers are not age dependent. Optimal testosterone has nothing to do with age, and that's a hard fact for some physicians to accept. A good way to look at it is as you would your vision. 20/20 vision is 20/20 vision regardless of your age. We don't say to an older man that he's to old to have optimal eye sight, we do what we can to help him improve his vision be it by glasses, contacts or surgery. I believe is was Dr. Abraham Morgentaler who first used this example and it's one of my favorites.

At your age, while you may indeed have low testosterone by the sound of your symptoms, we can't say it's due to age. You're not old enough for age to be the cause. Have you ever had an MRI on your pituitary? Have you ever experienced any head trauma or testicular damage? What about prior anabolic steroid or opiate use? Have antidepressants been a regular part of your life or any other type of medication? These are all important things the physician would need to know before you moved forward.

[k7979]

I've never had an MRI, never so much as tried opiates/steroids, nor have I had any significant head or testicular trauma. I had been on antidepressants for a short period when I was younger, but adderall is the only medication I am on now.


Do you think a urologist will be able to diagnose this or should I insist on meeting an endocrinologist?

[Justin]

I've never had an MRI, never so much as tried opiates/steroids, nor have I had any significant head or testicular trauma. I had been on antidepressants for a short period when I was younger, but adderall is the only medication I am on now.


Do you think a urologist will be able to diagnose this or should I insist on meeting an endocrinologist?

Your best bet would to be find a physician that is trained in low testosterone treatment. Rarely will this be an endocrinologist despite an endo being officially classified as a hormone doctor. I know this seems backwards, but most endocrinologist still treat low testosterone the same as they did 20-30yrs ago. They have evolved very little. This isn't to say all endos fall in this category, there are some good ones but they are a minority. The problem is many of these doctors follow the lab reference ranges only, meaning if your total testosterone is above 300 ng/dl they will consider you normal and in good health. They will not take into account free testosterone or estradiol.