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Pharma / TRT Testosterone Replacement
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Long time lurker, first time poster. Here goes …

-30 years old
-5’11
-34 waist
-200 lbs
-Ballpark 8% BF. Athletic build … cross fitter.
-Carry fat all in the lower abdomen
-Have been battling endos/Drs since first sexual experience 9 years ago. Unable to maintain erections. Get fatigued easily. Don’t recover from workouts quickly. Irritable. Short temper. I donâ??t recall the last time I woke up with a morning arousal. I have zero libido. I cannot focus at work. I have lost muscle mass from the gym and have a hard time maintaining my weight (200 lbs - used to be 228 lbs but a bit more BF) I am extremely irritable (ask my wife) and just have a general sense of not caring about anything. I lack energy (even though I sleep 9 hours a night generally) and canâ??t seem to stay up later than 10pm even on weekends.
-No Rx drugs; have been on Accutane in the past (has been 6 years since). Take whey/creatine/glutamine/BCAAs
-Paleo diet … looking at 2500 - 3000 kCals/day
-Crossfit 4x/week … have weight trained since I was 15. Crossfit last 4 years, Westside before that …

Here are labs (also attached in PDF … easier on the eyes.)

TEST RESULT (measure) RANGE (measure) High/Low
TSH 1.32 uIU/mL 0.25 - 3.0 uIU/mL
FT4 1.3 ng/dL 0.89 - 1.76 ng/dL
FT3 2.2 pg/mL 1.8 - 3.9 pg/mL
rT3 30.28 ng/dL 6.7 - 21.8 ng/dL HIGH
Anti-TPO Antibody <10 IU/mL <35 IU/mL
Anti-Thyroglobulin <20 IU/mL 0-40 IU/mL

Creatinine 2.9 gm/24hr 0.5 - 2.0 gm/24hr HIGH

Estrone 6.1 ug/24hr 3 - 11.4 ug/24hr
Estradiol 2 ug/24hr 0.8 - 4.6 ug/24hr
Estriol 3.1 ug/24hr 3.5 - 13/7 ug/24hr LOW
Total Estrogens 11.2 ug/24hr 7.3 - 29.7 ug/24hr

2-OH Estrone 7.3 ug/24hr 1.9 - 15.8 ug/24hr
16a-OH Estrone 2 ug/24hr 0.2 - 5.9 ug/24hr
2/16a Ratio 3.7 ug/24hr 1.2 - 4.9 ug/24hr

Pregnanediol 592 ug/24hr 70 - 1050 ug/24hr
DHEA 144 ug/24hr 100-2000 ug/24hr
Testosterone 68.5 ug/24hr 20 - 200 ug/24hr
5a-Androstendiol 46.2 ug/24hr 22 - 131 ug/24hr
5b-Androstendiol 103.6 ug/24hr 40 - 401 ug/24hr
Androsterone 4392 ug/24hr 2000 - 5000 ug/24hr
Etiocholanolone 2831 ug/24hr 1400 - 5000 ug/24hr

Pregnanetriol 2477 ug/24hr 200 - 1500 ug/24hr HIGH
Cortisone (E) 157 ug/24hr 31 - 209 ug/24hr
Cortisol (F) 142 ug/24hr 30 - 170 ug/24hr
Tetrahydrocortisone (THE) 3225 ug/24hr 2100 - 7400 ug/24hr
Allo-Tetrahydrocortisol (5a-THF) 2218 ug/24hr 700 - 3800 ug/24hr
Tetrahydrocortisol (THF) 1791 ug/24hr 1200 - 4500 ug/24hr
11b-Hydroxyandrosterone 675 ug/24hr 613 - 2298 ug/24hr
11b-Hydroxyetiocholanolone 549 ug/24hr 153 - 950 ug/24hr
Aldosterone 14 ug/24hr 6 - 25 ug/24hr
Allo-Tetrahydrocorticosterone (5a-THB) 972 ug/24hr 130 - 600 ug/24hr HIGH
Tetrahydrocorticosterone (THB) 244 ug/24hr 30 - 240 ug/24hr HIGH
11-Dehydrotetrahydrocorticosterone (THA) 254 ug/24hr 76 - 456 ug/24hr

Human Growth Hormone 4291 pg/24hr 1065 - 4722 pg/24hr

Free T3 1346 ng/24hr 470 - 1750 ng/24hr
Free T4 1808 ng/24hr 430 - 3200 ng/24hr

Sodium 183 nmol/24hr 40 - 220 nmol/24hr
Potassium 177 nmol/24hr 25 - 150 nmol/24hr HIGH
Sodium/Potassium Ratio 1 nmol/24hr 1.2 - 4.8 nmol/24hr LOW

SHBG 28.7 nmol/L 13 - 71 nmol/L

TOXIC METALS TESTS
Aluminum 140 ug/g creat <25 ug/g creat HIGH
Gadolinium 1.6 ug/g creat < 0.3 ug/g creat HIGH
Mercury 13 ug/g creat < 3 ug/g creat HIGH

From my untrained eye, it appears that DHEA and Testosterone are low while Cortisol is high. SHBG looks fine; thyroid looks fine. Pregnanetriol is really high — but it looks like that would be due to low cortisol which is not my case … so not sure what that is indicating.

Again, 30 year old male … looking to have kids w/i 1-2 years, so really trying to get myself all figured out.

Appreciate the help in advance.

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Urine tests are about as useful as a knife at a gunfight…

I assume the first set of thyroid labs you listed were blood tests? Definitely points to low cortisol. Get a an actual cortisol test (8 am blood test and/or 4x/day saliva test).

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Yes, correct. The upper ones are serum tests. Sorry for the confusion.

Also, I had LH come back at 2.20 mIU/mL on a reference range of 2 - 12 mIU/mL … so that is on the low end as well.

From the serum tests, would the ridiculously high rT3 indicate hypothyroidism? If so, does that adversely affect DHEA and T?

One more add too … I did have a set of serum tests done on my own on 3/25 … normal CBC work came back fine. Here are the thyroid/adrenal tests:

Thyroid panel:
TSH - 2.36 uIU/mL on a range of 0.45 - 4.5
T4 - 6.9 ug/dL on a range of 4.5 - 12.0
T3 Uptake - 35% on a range of 24 - 39
Free Thyroxine Index - 2.4 on scale of 1.2 - 4.9

Test:
Test, serum - 599 ng/dL on a scale of 348 - 1197
Test, free - 18.51 ng/dL on a scale of 5 - 21
%Free Test - 3.09% on a range of 1.5 - 4.2

Estradiol, Sensitive - 13 pg/mL on a scale of 3 - 70
IGF-1 - 252 ng/dL on a scale of 117 - 329
Prostate Specific Ag, Serum - 0.5 ng/mL on a scale of 0 - 4

4

Does anyone have experience with Wilson’s Syndrome? I’ve been reading a few articles about rT3 and some are pro-treating with T3 supplementation to lower rT3 and some are not. Would like to get some first hand advice.

Home - The Anti-Aging Medical Clinic…_syndrome.html
http://tiredthyroid.com/rt3.html

Also, as far as the low LH goes, would Clomid be a viable option to increase LH levels and thereby increase T levels to what they should be for a 30yo male? I know this doesn’t answer the thyroid issues, but…

5

Dude your Free Test is almost at the top top of the range. That is really good. You are looking at the wrong place for your issues.

I see your high RT3 and that is usually associated with low cortisol, causing pooling. I have seen a couple guys successfully clear high RT3 by taking a T3 only med (Cytomel) with a dose of Hydrocortisone (Cortef). This seemed to do the trick for them and they felt a ton better.

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Thank you.

Do you think Clomid would help? LH is super low normal, so I am thinking that if I can increase that in addition to fix the thyroid issues I would be set

I appreciate your help

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[quote]mjl279 wrote:
Thank you.

Do you think Clomid would help? LH is super low normal, so I am thinking that if I can increase that in addition to fix the thyroid issues I would be set

I appreciate your help[/quote]

NO!!! Your Testosterone levels are fine, therefore your LH levels are fine…

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Even if LH came back at 2.2 on a 2-12 scale?

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Do you even know what LH does?

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I do. LH stimulates the leydig cells in the testes to produce testosterone.

Reason I ask is per the urine labs (and even serum), testosterone is on the low range of the scale for a 30 year old male.

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I am one of the guys who “cleared” his RT3 but understand RT3 is normal and you need it. You just don’t want it too high. The best approach is to solve the problem that caused it to go out of control in the first place. For me it was low iron.

The half life of the cells and RT3 is short enough it will clear itself if you fix what is causing the excess RT3 creation.

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[quote]mjl279 wrote:
Reason I ask is per the urine labs (and even serum), testosterone is on the low range of the scale for a 30 year old male. [/quote]

o rly?

[quote]mjl279 wrote:
Test, free - 18.51 ng/dL on a scale of 5 - 21
[/quote]

You are in the upper 90% of the range. What more do you want?

As I keep saying, look elsewhere for the cause of your issues.

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[quote]Pushinit wrote:
I am one of the guys who “cleared” his RT3 but understand RT3 is normal and you need it. You just don’t want it too high. The best approach is to solve the problem that caused it to go out of control in the first place. For me it was low iron.

The half life of the cells and RT3 is short enough it will clear itself if you fix what is causing the excess RT3 creation. [/quote]

Good post. Forgot to mention that the cause of the problem in the first place also has to be addressed. Sometimes though this is not hormonal but related to a temporary sick state that the body just didn’t recover from properly. So in those cases, the stressor is already identified and removed. But yeah, iron, ferritin, liver clearance are all issues to look for.