16 year old, anyones opinion?

[mobrien]

I am a 16 year old in highschool and about a year ago I had some
blood work done because for the past year I have been feeling the following symptoms:
Fatigue, weakness, constant hunger, cold hands feet and intolerance, and overall lack of energy and sex drive.
in everything I used to do. The blood work came back with extremely low tesosterone,
What triggered all of this happened a year ago in the summer of 2008. Starting the summer around June I weighed 130 lbs and just got
done competing at state wrestling. When that was over I decided to cut down for next
year right away to have a better chance at doing better in wrestling.
I started eating less and less, and eventually lost 15 pounds. All of this ended around
September, so from June-September around four months I had pretty much developed an
eating disorder from my favorite sport. Before this I was at a healthy weight and
develping normally.
I have seen two endocrinologists in Iowa and have been to Mayo clinic, Rochester, MN
because they are the best at handling these problems.
IThank you for your time.
Llevels go as follow: FLAG
T4 (Free) 1.04 (0.89-1.76)
TSH 1.17 (.35-5.50)
LH 2.2 (1.5-9.3) L
FSH 2.5(1.4-18.1) L
Testosterone 96.7 (241-827) L
Normal CBC and Comp Metabolic
Ferratin 146.9 (22-322)
B-12 571 (211-911)
Folate 24.0 (5.38-19.64)
Hemoglobin 11.9 (13.0-16.0) L
RBC 3.97 (4.70-6.10) L
Hematocrit 34.5 (39-50)
IGF-1- 243 range (257-601) L
IGFBP-3 2.5 (2.5-4.8)
ACTH 4:00 p.m 23 (10-60) a.m range
Cortisol 12.2 (4.0-11)
DHEA 500 (250-900)
Estradiol 20 (10-36)
Prolactin 6.3 (2.6-18.1)-Don't think there's a tumor.
Androstendion 82 (44-186)
CBC AND DIFFERENTIAL all normal
WBC Normal
RBC Low L
Iron TIBC 88 (49-167)
Glucose 79 (70-110) Non-fasting
Total Protein 7.1 (6.4-8.2)
Albumin 4.9 (3.7-4.9)
Calcium 9.6 (8.4-10.6)
Alkaline Phosphatase 77 (32-122)
Total Bilirubin 0.2 (0.2-1.2)
ALT 21 (0-55)
AST 23 (12-42)
BUN 26 (8-21)


.
Creatinine 1.0 (0.4-1.3)
Sodium 143 (136-145)
Potassium 4.8 (3.6-5.2)
Chloride 105 (96-108)
CO2 28 (23-33)

[nasdaqphil]

I am a 16 year old in highschool and about a year ago I had some
blood work done because for the past year I have been feeling the following symptoms:
Fatigue, weakness, constant hunger, cold hands feet and intolerance, and overall lack of energy and sex drive.
in everything I used to do. The blood work came back with extremely low tesosterone,
What triggered all of this happened a year ago in the summer of 2008. Starting the summer around June I weighed 130 lbs and just got
done competing at state wrestling. When that was over I decided to cut down for next
year right away to have a better chance at doing better in wrestling.
I started eating less and less, and eventually lost 15 pounds. All of this ended around
September, so from June-September around four months I had pretty much developed an
eating disorder from my favorite sport. Before this I was at a healthy weight and
develping normally.
I have seen two endocrinologists in Iowa and have been to Mayo clinic, Rochester, MN
because they are the best at handling these problems.
IThank you for your time.
Llevels go as follow: FLAG
T4 (Free) 1.04 (0.89-1.76)
TSH 1.17 (.35-5.50)
LH 2.2 (1.5-9.3) L
FSH 2.5(1.4-18.1) L
Testosterone 96.7 (241-827) L
Normal CBC and Comp Metabolic
Ferratin 146.9 (22-322)
B-12 571 (211-911)
Folate 24.0 (5.38-19.64)
Hemoglobin 11.9 (13.0-16.0) L
RBC 3.97 (4.70-6.10) L
Hematocrit 34.5 (39-50)
IGF-1- 243 range (257-601) L
IGFBP-3 2.5 (2.5-4.8)
ACTH 4:00 p.m 23 (10-60) a.m range
Cortisol 12.2 (4.0-11)
DHEA 500 (250-900)
Estradiol 20 (10-36)
Prolactin 6.3 (2.6-18.1)-Don't think there's a tumor.
Androstendion 82 (44-186)
CBC AND DIFFERENTIAL all normal
WBC Normal
RBC Low L
Iron TIBC 88 (49-167)
Glucose 79 (70-110) Non-fasting
Total Protein 7.1 (6.4-8.2)
Albumin 4.9 (3.7-4.9)
Calcium 9.6 (8.4-10.6)
Alkaline Phosphatase 77 (32-122)
Total Bilirubin 0.2 (0.2-1.2)
ALT 21 (0-55)
AST 23 (12-42)
BUN 26 (8-21)


.
Creatinine 1.0 (0.4-1.3)
Sodium 143 (136-145)
Potassium 4.8 (3.6-5.2)
Chloride 105 (96-108)
CO2 28 (23-33)

Hello and welcome.

So...16 year old wrestler with low Test AND low IGF-1. What did Mayo clinic say?

My first question as an old HS football player back in the day, what type of supplements are you using? Have you taken ANY steroids? Have you taken any steroid precursors? Anything, legal or illegal?

I don't know how it is these days in school but back in my day competition was firece and steroid use among HS athletes was common. I personally never took them but took plenty enough precursors, vitamins, herbs, etc to the extent that I am still convinced it had something to do with my really low testosterone - except Im 39 now.

Assuming you did not take any type of drugs or special supplements, did Mayo give you a pituitary MRI? I assume they physically checked you out downstairs as part of the workup.

Did they say you had hypogonadism?

I really don't have much to offer but would like to know what Mayo said. My first guess is that you dieted yourself into a hole - perhaps too much, too soon and your body was not getting the essential fats, proteins and carbs required to produce testosterone. If that's the case, your testosterone would restore after eating properly again for a while.

I know we see it in anorexia - where so few calories are eaten the sex hormones get really screwed up - in women they will stop having periods, etc.

Have you had any trauma down there? A good shot in the you-know-whats during a workout or anything like that? Kick in the groin?

Are you wearing any special suits/jock/underwear that is keeping the boys too tightly wrapped perhaps?

Im obviously just throwing some thoughts out there for ya. At your age I am hesitant to offer much since we are not doctors here. I think you have a good chance of getting everything sorted at Mayo - they are very good at what they do.

[Andros]

I am a 16 year old in highschool and about a year ago I had some
blood work done because for the past year I have been feeling the following symptoms:
Fatigue, weakness, constant hunger, cold hands feet and intolerance, and overall lack of energy and sex drive.
in everything I used to do. The blood work came back with extremely low tesosterone,
What triggered all of this happened a year ago in the summer of 2008. Starting the summer around June I weighed 130 lbs and just got
done competing at state wrestling. When that was over I decided to cut down for next
year right away to have a better chance at doing better in wrestling.
I started eating less and less, and eventually lost 15 pounds. All of this ended around
September, so from June-September around four months I had pretty much developed an
eating disorder from my favorite sport. Before this I was at a healthy weight and
develping normally.
I have seen two endocrinologists in Iowa and have been to Mayo clinic, Rochester, MN
because they are the best at handling these problems.
IThank you for your time.
Llevels go as follow: FLAG
T4 (Free) 1.04 (0.89-1.76)
TSH 1.17 (.35-5.50)
LH 2.2 (1.5-9.3) L
FSH 2.5(1.4-18.1) L
Testosterone 96.7 (241-827) L
Normal CBC and Comp Metabolic
Ferratin 146.9 (22-322)
B-12 571 (211-911)
Folate 24.0 (5.38-19.64)
Hemoglobin 11.9 (13.0-16.0) L
RBC 3.97 (4.70-6.10) L
Hematocrit 34.5 (39-50)
IGF-1- 243 range (257-601) L
IGFBP-3 2.5 (2.5-4.8)
ACTH 4:00 p.m 23 (10-60) a.m range
Cortisol 12.2 (4.0-11)
DHEA 500 (250-900)
Estradiol 20 (10-36)
Prolactin 6.3 (2.6-18.1)-Don't think there's a tumor.
Androstendion 82 (44-186)
CBC AND DIFFERENTIAL all normal
WBC Normal
RBC Low L
Iron TIBC 88 (49-167)
Glucose 79 (70-110) Non-fasting
Total Protein 7.1 (6.4-8.2)
Albumin 4.9 (3.7-4.9)
Calcium 9.6 (8.4-10.6)
Alkaline Phosphatase 77 (32-122)
Total Bilirubin 0.2 (0.2-1.2)
ALT 21 (0-55)
AST 23 (12-42)
BUN 26 (8-21)


.
Creatinine 1.0 (0.4-1.3)
Sodium 143 (136-145)
Potassium 4.8 (3.6-5.2)
Chloride 105 (96-108)
CO2 28 (23-33)

Hi there Mobrien and welcome to the board. Here you can read of the possible causes of low LH.......

http://www.labtestsonline.org/understanding/analytes/lh/test.html

And, I would like to comment that while your FT4 is in range it is low. Mid-range would be 1.32 and we like to see it at least there or a tad higher. Same info is true for FSH "except" for the various medications that can cause low results in both of these. Nasdaqphil has touched upon this. Are you on any medications? You can read what those meds are in the url provided above. After you read LH, just put FSH in the search engine and any other you like. It's a terrifically helpful site.

Folate over range is interesting...........

Increased folate may be seen with pernicious anemia and with vegetarian diets. "However, your Ferritin looks good and this is the protein that binds your iron for cellular uptake.)

Low hemoglobin and hematocrit also point to anemia. Interestingly, low hemoglobin, billirubin and hematocrit point to cirrhosis of the liver or possibly hepatitis.

Clearly you have some medical issues here and like, Nasdaqphil, I wonder what the docs at Mayo have said? Are you to go for further testing?

[mobrien]

Hi there Mobrien and welcome to the board. Here you can read of the possible causes of low LH.......

http://www.labtestsonline.org/understanding/analytes/lh/test.html

And, I would like to comment that while your FT4 is in range it is low. Mid-range would be 1.32 and we like to see it at least there or a tad higher. Same info is true for FSH "except" for the various medications that can cause low results in both of these. Nasdaqphil has touched upon this. Are you on any medications? You can read what those meds are in the url provided above. After you read LH, just put FSH in the search engine and any other you like. It's a terrifically helpful site.

Folate over range is interesting...........

Increased folate may be seen with pernicious anemia and with vegetarian diets. "However, your Ferritin looks good and this is the protein that binds your iron for cellular uptake.)

Low hemoglobin and hematocrit also point to anemia. Interestingly, low hemoglobin, billirubin and hematocrit point to cirrhosis of the liver or possibly hepatitis.

Clearly you have some medical issues here and like, Nasdaqphil, I wonder what the docs at Mayo have said? Are you to go for further testing?

Never any prohormones or AAS the low testosterone I have been told can cause slightly low RBC which I have with the anemia. Ever since that extreme diet and weight loss I have been a normal dude, normal puberty, Strong, athletic, young man with no health problems.
I have been given androgel now for a while on a low dose, there is still and underlying problem but I have no clue what.

[Andros]

Never any prohormones or AAS the low testosterone I have been told can cause slightly low RBC which I have with the anemia. Ever since that extreme diet and weight loss I have been a normal dude, normal puberty, Strong, athletic, young man with no health problems.
I have been given androgel now for a while on a low dose, there is still and underlying problem but I have no clue what.

Do you still think you have a thryoid problem? Are you going to get the suggested antibodies' tests?

TPO (antimicrosomal antibodies), TSI (thyroid stimulating immunoglobulin) and Thyroglobulin Ab.

In what ways are you currently symptomatic?

[mobrien]

Can one have normal tsh with hypothryoidism?

[GD Women]

Some say yes, some say no. I say no.

Do you have any more information.

What is her TSH level and was FT4 and FT-3 done or any other thyroid related test.

[CA-Lynn]

Hi, Mobrien,

Kudos to you for seeking information. I'm a fan of Mayo, too, and would really be interested in knowing what they said and what the plan of action is.

In the mean time, I went through some of your out-of-normal-range values and am listing possible causes. CAUTION! This does not mean you have ANY of these things......all are just possibilities found in the greater population.

Sadly, eating disorders are all too common in this sport.

Folate 24.0 (5.38-19.64) Can we attribute this to eating folate-rich foods or taking more than necessary Folic Acid supplements?

Hemoglobin 11.9 (13.0-16.0) L: Possible causes:
Anemia
Liver disease
Hypothyroidism
B-12 Deficiency
Folate Deficiency [which isn’t the case here!]
Early iron deficiency anemia
Anemia caused by chronic disease
Hemolytic anemia
Acute hemorrhage
Microcytic Anemia
Iron deficiency
Thalassemia

RBC 3.97 (4.70-6.10) L
Generally indicates anemia

Hematocrit 34.5 (39-50)
Possible rheumatoid disease.

IGF-1- 243 range (257-601) L
Chronic stress; fibromyalgia

Cortisol 12.2 (4.0-11)
Depends on the time of day the test was taken. [But ACTH looks good.]

Albumin 4.9 (3.7-4.9)
Could be the result of restricting food.

BUN 26 (8-21)
Impaired kidney function
Dehydration
High protein diets
Strenuous exercise
Steroids
Cyclosporine
Other gastro-intestinal issues

Some years back I took prescription diet pills and found it did a real number on my lab work. My values looked as though my body was in a state of malnutrition.

If it's any consolation, your numbers do not appear to be critical....but I'm certain your doctors probably suggested that you repeat some of the tests at a certain point in time.

I can understand your concern about the testosterone. How has your blood pressure been? This can have a bearing on testosterone levels. [Pay attention, men!] Often men with diabetes have problems with low testosterone, so if they haven't run one, you might ask for an A1C test [which measures the last 90 days of your blood sugar, not just the here and now]. Doesn't seem that diabetes is the culprit in your case, but still possible in spite of the normal glucose number.

I think Nasdaqphil and Andros pretty much narrowed down some possibilities.

Just to put your mind at ease: sometimes just one little thing in your body can go whacko and it sends the rest of it in a tailspin.

Were you taking any supplements [OTC stuff to supplement your diet] before they ran the test?

[CA-Lynn]

"Can one have normal tsh with hypothryoidism?"

I believe it's possible at the very beginning of the disease.

[mobrien]

I do not feel as though it is diabetes, or at least not type two just because my fasting insulin was very low, and if I was resistant it would have been elavated. Can one live normally on thryoid replacement?

[Andros]

Can one have normal tsh with hypothryoidism?

It can be in the normal parameters of the suggested range; yes!

Bring us up to date on your progress. We have not seen or heard from you in a long time.

Did they do antibodies' tests? Are you on thyroxine replacement?

[CA-Lynn]

Mobrien,

Re diabetes: There are many diabetics who have blood levels all over the place at any given time.

MANY, MANY people with hypothyroidism live perfectly normal lives.

You never did tell us what Mayo said.

[mobrien]

I've had my glucose drawn about seven times in the last 6 months and each time it is between 74 and 90 so I am going to put the diabetes possibility aside for now. There is evidence, though, of a thyroid issue (mainly the low t4 and t3) even if my tsh is not elavated, this is where I will start. Maybe 2.0 for TSH is too high for me? When I was healthy it may have been .90 or something along those lines.

[CA-Lynn]

Just for the record:

I'm assuming the glucose test was the standard test, which leaves much to be desired. It only measures the glucose at the moment the blood was drawn. It does not measure the activity over a 90 day window. Therefore, you could be perfectly normal at certain times of the day and the rest of the day abnormal.

GTT and the A1C tests are FAR better indicators of diabetes.

Just hold on to that information.

IF it was me, I'd look into the pituitary first.

[mobrien]

Way ahead of you on the pituitary thing. I went ahead and had my doctor prescribe me clomiphine citrate, which is a SERM (selective estrogen receptor modulator) that raised my LH from 2.2 to 23.0 and testoterone from 237 to 849 which shows that my pituitary is working, I'm just shutdown. My question for you then is, how much does the GTT or A1C1 test cost?

[nasdaqphil]

So if your pituitary is sending the proper signals to the "boys" but the "boys" are not producing enough testosterone, you have your answer, do you not? If my logic is correct, it appears to be a problem within the testes themselves. What did the docs say about that test?

Next, I was going to ask if your father, brother, mother's Dad.....anyone real close has issues? I know lower testosterone can run down the family line. Has your father or mother's brother ever had a similar problem? Have you asked around?

You said you had a good contrast pituitary MRI, correct? If not, try to find yourself a good 3T (3 Tesla) MRI machine in your area. The new 3T machines are really strong and can see a lot of things other MRI's cannot.

[mobrien]

Reread the post..I said testosterone went from 200 to 800..meaning the boys work as well..?

[CA-Lynn]

I wouldn't rush out to get it done, but the next time you have labwork done, ask your MD to add A1C. It would be a fairly reliable way to rule out diabetes. [Or rule it in. for that matter.]

Some physicians, particularly endocrinologists, have the finger prick A1C version in their offices. Mine does. My insurance picks up most of the cost..... not sure, but if I had to pay out of pocket I think it's between $30-45.

I just checked and you can buy it from your pharmacy or online for about $30.
http://www.drugstore.com/qxp228355_333181_sespider_1_1/bayer/self_check_at_home_a1c_system_a1cnow.htm

I'd wait on the OGTT [Oral Glucose Tolerance Test] pending the results of the A1C. That one you'd have to go to a lab for.....it's where they draw blood and then you drink a very sugary drink, then then draw your blood at certain intervals - one hour, two hours.... Not sure what the cost of that one is.

[mobrien]

I honestly do not beleive it could be diabetes. I have been to Mayo clinic and looked at by some of the most highly regarded endocrinologists in the country, possibly world. I cannot see them making that big of a misdiagnosis..I am sorry if it offends you.

[CA-Lynn]

Mobrien,

Of course it does not offend me at all.

We've been asking what Mayo diagnosed and you haven't responded.

I would just want to be thorough and while Mayo is excellent, they are capable of making mistakes. All I am suggesting is to rule it out [since they did not] by asking for the A1C the next time you have bloodwork done.

Now perhaps there is more bloodwork that was run that you didn't post. Maybe A1C was run and you didn't post it. Or GGT. You mentioned insulin, but I didn't see any insulin test on your list.

Again - just put it on the backburner.