IMO, your ft4 was raised proportionally higher than your ft3, so that might indicate you have poor t4->t3 conversion (just guessing here) and might do better on dessicated thyroid.
More importantly - while it’s good your TSH went down, did you SYMPTOMS lesson during that time? This is far more important.
I’m not familiar with these lab ranges but typically your morning cortisol should be at the very top of the range, so it is a bit low (should be near 700). Your adrenals need to be in order before you go about fixing a thyroid issue. I’m thinking a 4-point saliva test could be warranted, in addition to RT3, ferritin, and thyroid antibodies.
I do not know how hard these would be to get in Canada.
My TSH did go down a bit, but on 25mcg of T4 meds it is not even close to the amount I would need to get the number down to where I want it. All my symptoms were still there but to expect them to go away from such a slight change would be hoping too much.
I don’t actually think I’m having poor t4 to t3 conversion. T4 is at 73% and T3 is at 68% with both numbers increasing about the same percentage between tests. I will keep it in mind though if I can ever get access to some real medication.
I don’t believe I can get RT3 test except for specific labs in Ontario, only one I know about is 6-7 hours from me.
I planned to get many other tests but couldn’t because of no script for the blood work since the doctor didn’t want to have anything to do with me. He said he would only write the blood tests if I took testosterone treatment from him.
My other appointment is June 14th so about a week away, which I’m traveling 5-6 hours to get to. Hopefully I get some more positive results but I think I will since he was recommended from NeelyDan.
I’ve had many tests done so far but there is some I want to get out of the way to see if I’m/doctors are missing something.
This is a list of things I want to test again or want for new tests and/or to talk to doctor about:
Ferritin
Estradiol sensitive E2
TSH
ft4
ft3
Thyroid Antibodies hashimoto’s/Grave’s
SHBG
DHEA-S(Sulphate)
Total T
Free T
LH
FSH
Vit_D25 oh total
Complete Blood Counts
progesterone
Pregnenolone
Iron
Copper
New blood work is in. A few things I’m not too sure about, so please give all feedback possible. Helps a ton for giving research points I can use myself too.
Blood work was really intensive so I’ll list everything and post some notes after.
Notes of interest:
-TSH is down from around 3 to 1.82 from 25mcg synthroid? Off it now though, but stil have same symptoms even with lower TSH. Should be trying to raise ft3 values?
-DHEA-S is low, really low. Kinda surprised here at its number. Direct supplementation or wait see how it reacts to other medication?
-LH/FSH still rock bottom at 1 and 2.
-Free Test is still clinically low
-Total test is low, not clinically though. It’s actually highest its ever been on blood work.
-Vitamin D at 157 of 75-250 range, is that good enough or should I increase supplementation? At 6000IU now.
-DIHYDROTESTOSTERONE (DHT) I didn’t expect this to come back high, not really sure what to make of it.
Your Vitamin D plan looks good…maybe increase to 8k…
Mate, if I were in your situation, I would really focus on the low T…I hate to sound like an idiot doc but your thyroid does not appear to be struggling…sure your ft3 value could be a bit higher, and your TSH could be a bit lower, but you have tried thyroid meds and they don’t work…you also have an obvious problem with Low T (secondary) so I would try to get that under control before worrying much more about thyroid…
which brings us to:
Very surprising that your DHT is so high given your Low T…this could actually help to explain your Low T, since your body is recognizing excess DHT and downregulating LH/FSH to compensate (DHT is part of this HPTA feedback loops just as much as Test is), which leaves less T (to convert to DHT)…so that puts you in a bit of a catch 22, and doesn’t really explain why your DHT is high to begin with…
Your situation is not one I have encountered anywhere, nor one I can really wrap my head around…it is possible that you have an overactive 5 Alpha Reducatase (5AR) enzyme activity, which is the process your body uses to convert T to DHT…you could POSSIBLY consider some sort of 5AR Inhibitor (i.e. “hair loss meds”) to see if you get a drop in DHT and a corresponding rise in LH/FSH, and thus T.
Your low DHEA makes that situation even trickier…since your DHEA is low, even if you sort this other feedback loop out, your body might not have the raw material to make T…oooooorrrrrr your body may just be currently downregulating your DHEA in order to spare it from making T (your body doesn’t want T right now)…
Quite a prediciment…
Of note, what does your hairline look like? Any prostate issues to speak of (trouble urinating, frequent urination in night, etc)?
Yeah, it sure is an interesting situation…especially for someone only 23 and never abused any drugs or anything like that.
I got a full head of hair and hair all over, nothing crazy but not lacking.
I’ve never had prostate checked since doctor’s always said I’m too young to worry about it.
No problems urinating and I usually sleep a full nights sleep without interruption, sometimes I’ll wakeup once to take a piss but a got a good bladder I’d say.
I suspected as much–the link between DHT and hair loss/prostate issues is very overrated IMO…the real link lies in E2, which for whatever reason the majority of the medical community seems to ignore…but I digress…
Do you have any thoughts about any of my recommendations? What is your way ahead?
You didn’t give any lab ranges for cortisol or cholesterol. If your cortisol was an 8am draw, and you had the same lab range as the first set of tests you posted, it is still low. It is in the middle-low end of the range, but should be right near the upper boundary.
Low cortisol, low DHEA, low T… I’m sensing you probably have low cholesterol and poor adrenal function. But I’m not sure how to reconcile that with your huge DHT numbers.
I might be out of my league with your case but it sounds like you are looking for any input possible.
Also, why did you stop your t4 meds if it improved your TSH? I’m confused there. (BTW, if your TSH improved but you didn’t feel better, that could be another indication of poor adrenal function).
The sheet doesn’t give lab ranges for cortisol or cholesterol. All my tests were done around 8AM.
Also, thanks for pointing out stopping my t4 meds. That was from another doctor who gave me 25mcg for 2months before stopping my prescription and sending me to an endo…who was horrible. But would of shown the change for this latest blood work.
I just called my doctor and mentioned this and he agrees I should still be on some thyroid medication and will put me back on 25mcg on Synthroid and further evaluate how to medicate it in the future.
So current protocol:
250iu HCG Monday/Thursday
320mg of Saw Palmetto per day in morning (need find where buy this stuff, hope its not crazy expensive)
25mcg Synthroid per day
No reference range is a problem. Hypothyroid requires thyroid meds for life (synthroid does not fix your thyroid, just gives you t4). However if poor adrenals are what caused your original high TSH, then you may not be hypothyroid.
If you felt no better even with a near optimal TSH, then adrenals may be your root problem.
A little off the beaten path but… do you have indigestion? How’s your fat intake? Your body makes cholesterol from fat, so if you aren’t eating/absorbing enough of it, then you don’t have the base ingredient for these reactions.
I think something else is probably the cause, but I don’t know what else to suggest at this point.
CHOL is not terrible by any means…a bit on the lowish side, but shouldn’t cause that many issues…
May still want to eat more dietary cholesterol if not doing so already…
I think the doc’s recommendation is pretty sound (obviously since it was essentially what I suggested!)…the saw palmetto acts as a 5AR inhibitor and should bring your DHT down…may stimulate your HPTA if it weren’t for the introduction of the HCG (which I don’t have a problem with per se)
hcg should stimulate your testes into making T if they are capable…If you do not notice an improvement after a few weeks (confirm with blood tests), then add a little DHEA (50-100 mg/day) to your regimine and see if adding more raw hormone helps…this may be a problem since you are in Canada and can’t get it OTC…if you were Ameican, I would actually recommend to supplement DHEA before taking HCG since it is the least invasive/costly option, followed by hcg…but in your situation, it effectively doesn’t matter since both are a PITA…
If you don’t get any reaction from the combination, then there would be no need to try a SERM since your body has already shown that your testes can’t produce T and exogeneous TRT will be the only way to go…
Yeah I thought that was pretty cool that he suggested what you said, I think I found a keeper in the doc department. Expensive though for a student.
I’m pretty much doing that protocol until September for the new blood work, but if I feel worse I’d obviously send him an email earlier. I’ll keep the DHEA in mind but he mentioned it at my 1st in person appointment. I don’t think he wanted to give me everything at once since I’m pretty sure the DHT number caught him off guard also.
Hopefully TRT isn’t needed…that is the reason I’ve been looking so hard to find a good doctor. I did discuss TRT with him thought and he gave me the option to go that way in the future with HCG and AI’s if needed. He did mention he thought my E2 was low…didn’t think <70 in range <150 was low…but our E2 system in Canada is beyond messed.
I eat 4 whole eggs for B-Fest every morning and eat about a 30% fat diet so I think my diet is good. At 2600 calories right now which is keeping me near same weight. Good digestion also, sometimes constipation but taking some flax seed solves that right away.
I’m interested in how this DHT lowering and T increases does with acne…since I’ve been on accutane twice now and doctor didn’t know what was causing it.
Did you mention that you were on accutane in an earlier post? If not, you should have…it has some very nasty sides…if you google search “accutane and low testosterone” you get about 472,000 hits…
Yeah I mentioned it. I was on 60mg for 6 months then 80mg for 3 months for the 2 terms. Not on it anymore now though. It did get rid of the acne though during the terms and currently don’t have any problems with it…but same thing happened after 1st term and eventually came back.
Been about 1 1/2 weeks now on HCG/25mcg T4 and two weeks on 320mg Saw Palmetto.
Don’t feel any different, thought the HCG would work faster and I’d be able to tell. This normal? Maybe its just too early and my system hasn’t gotten in gear yet. Just would like to know its working and not have to worry about testosterone treatment as the upcoming option if tests in September show current protocol not working.
Got a call from my endo that I saw awhile back. He said he referred me to the Mount Sinai Hospital care center near Toronto. Now currently I’m with a wellness center doctor, who I think is doing a good job, would it hurt to follow through with this Hospital also? I’ve been told they are one of the top hospitals in Canada…but I’m not sure if that is good or bad considering I’m looking for a hormone specialist. I’ll be placed on a waiting list, but I should be fine as long as I tell them I’m getting treatment from a doctor I found at a wellness center right?
Got another blood test done, will post full results soon. Doctor said I’ll have it emailed to me within a few days. I already had my appointment though and got some main numbers.
Free Testosterone 24.8 (31.0-94.0) increased to 25.9 (31.0-94.0)
DHT lowered to 3152 from 3499 (860-3406)
DHEA was still flagged low and TSH was in the 1.0 range with decent ft4 and ft3.
My protocol was:
250iu HCG Monday/Thursday
320mg of Saw Palmetto per day in morning (need find where buy this stuff, hope its not crazy expensive)
25mcg Synthroid per day
It is quite evident that HCG treatment didn’t work sadly. Testosterone didn’t even move basically. Talked about injection/cream options and going with injections.
New protocol:
50MG Test Monday/Thursday(100 total mg) Sub-Q
250iu HCG Monday/Thursday
320mg of Saw Palmetto per day
25mcg Synthroid per day
25mg DHEA per day.
Get new blood work in 6-9 weeks and see how things go, keeping an eye to see if estrogen blocker will be needed.
Pretty much what I was expecting if the HCG didn’t work to raise testosterone by itself. Sucks going on lifelong treatment at age 23(24 next month), but I’ve been trying to find other ways now through other doctors and such for almost 2 years…still no reason why my numbers are low, but guess I’d rather be on TRT I think then keep going on like I am now.
Does anyone have problems drawing Test with insulin needles?
Doing Sub-Q Test and HCG, should I use different sites? What are the norms? I was thinking HCG continue stomach area and Test into thighs?
Also, DHEA is freakin expensive. $85 I think the pharmacy person told me. I was looking at prices in USA and the stuff is like pennies compared. Too bad can only get it legally in Canada through pharmacy.
Anyway, thanks for all help people on the forum! If ya have any feedback or question answers for me its appreciated.
I would try to top off DHEA levels before committing to lifelong TRT. You may be able to order it, I have no idea. But if you’re taking it anyway, might as well give it a shot for a while and see if you notice any improvements. I would think 4-6 weeks trial.
If you do decide to go ahead with your protocol, I wouldn’t use HCG right away. Personally, I haven’t needed it. You did not mention an AI for E2 control–is that an option later?
I pin my Test IM into my deltoids using a 30 gauge insulin pin and it works fine. SC also works, but I have never done it.
HCG should be done SC into the stomach fat. There are many youtube videos about how to do this now that the HCG diet is being popularized.
It seems that the Saw Palmetto has brought down my DHT which is good. The HCG wasn’t able to raise free or total testosterone by itself. Thyroid looks okay now on 25mcg synthroid. DHEA also still really low.
I’m going to follow the doctors advice and go with test cyp injections, 100mg weekly twice per week sub-q.
Also the DHEA was $80 for a 3 month supply, I can live with that. Everything else besides the saw palmetto is covered by insurance for now since I’m in college still.
Did my first injection of Test-Cyp today with insulin needle and it was fine. Took awhile to load which I expected but not too long. Need some practice injecting it though since it kind of goes slower then I’d like and want to push the plunger harder =/.
Next blood work be in about 4-6 weeks and I guess we see how this goes…might need something for estradiol if it raises with the test and DHEA which is a possibly scenario. Doctor said he wouldn’t have a problem with giving estradiol blocker if needed.
Current Protocol:
50MG Test Monday/Thursday(100 total mg) Sub-Q
250iu HCG Monday/Thursday
320mg of Saw Palmetto per day
25mcg Synthroid per day
25mg DHEA per day.
Also, I’m not taking the chance of not using HCG with the protocol…too many benefits with it I think. Especially since I’m young ;). Haven’t had any problems with injecting into stomach fat so going keep doing it.
I agree with VT I would’ve tried to top off DHEA before commiting to TRT. DHEA is needed for T and you can’t expect to build a house with no bricks. Personally I’d rather take DHEA pills than inject T for life, but that’s just me.
I wish you could get a more sensitive E2 test but that has already been covered in this thread.
Seems like testosterone is going up, finally have DHEA up, went from 25 to 50mg with getting some blood work at the mid-way point and it was still low.
ESTRADIOL is real high. Tried taking some Miraforte with Crysin to lower it naturally but didn’t work. Only real option now is going to prescriptions AI compound, which is the plan.
DIHYDROTESTOSTERONE is real high, don’t have any problems with baldness or prostate, talked to doc about this and he doesn’t think its a major concern right now. Said he rather it be lower obviously, but doesn’t want to use prescriptions to bring it down right now. Still taking saw palmetto for it though since it helped bring it down abit last time. Going to try and tackle ESTRADIOL 1st then come back to DHT once other numbers are better. Any ideas on this? Seems that DHT is pretty complicated and many people have different views about it and healthy levels.
Vitamin D going down bit since winter coming up in northern Ontario here so uping Vitamin D dosage to 11,000iu. Current was at 6,000iu.
Past Protocol:
50MG Test Monday/Thursday(100 total mg) Sub-Q
250iu HCG Monday/Thursday
320mg of Saw Palmetto per day
25mcg Synthroid per day
50mg DHEA per day.
New Protocol:
50MG Test Monday/Thursday(100 total mg) Sub-Q
250iu HCG Monday/Thursday
320mg of Saw Palmetto per day
25mcg Synthroid per day
50mg DHEA per day.
Arimidex compound twice per week.
for a student.