Your iron is low too, but that may come up when the B12 does. Any idea what your folate level is?
My iron has improved than before. I never did folate level test, i can test that in my next blood test. So 1000mcg a day will make my vitamin b12 level upto 600? or do i have to increase dosage? do you think that hot burning and pins like feeling on bodycan be because of enanthate oil? Should i change it to cypionate?
I take 1000mcg methylcobalamin daily and my levels are literally the top of the range
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Why are you taking thyroid hormone medication? There is no reason to do so with these levels.
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I dont know if it is mentioned somewhere in your thread, but it seems your morning cortisol is really low. I would do 4 points saliva cortisol test and if it shows all time low I would try tu suplemment with adrenal cortex. Optimal cortisol throughout a day is a must.
Again even your thyroid results show that your cortisol levels are lacking. You have hight fT3 and your symptoms are still present. You are pooling (your T3 cant make it to your cells because of inadequate cortisol levels or low aldosterone/iron) your T3 and that is why your rT3 is high.
I think armour isn’t a right choice for you, you would need only t3 (cytomel) to clear rT3 receptors with it (lower your rT3) and adrenal cortex and if your cortisol is seriously low you need to get HC (hydrocortisone).
There is no scientific evidence that testing saliva cortisol is sensitive or specific enough to diagnose adrenal insufficiency.
rT3 has no diagnostic value in other than the critically ill patient.
Cortisol has a high diurnal variability. In one test hist cortisol was almost 400 which has a very high negative prediction value. In case of primary adrenal insufficiency ACTH would be increased which is not the case.
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Dude, where do you take this from the endocrine society’s crap?
Most progressive HRT physicians know how important RT3 for optimal thyroid work is, that it is decreasing the amount of FT3 and also blocking the T3 receptors of the cells and that high RT3 should be addressed. And most of the stupid endos dont even test it
Well, so tell me why so many hypothyroid patients have benefited from cortisol supplementation either from AC or HC? You just need right amount of cortisol for T3 to go into your cells. Saliva test can show you where your cortisol stands during the most crucial time of the day.
Of course there are different treatments for high cortisol/low cortisol/ Low high cortisol etc. From clinical point of view, hippocampus has the biggest amount of cortisol receptors of all the brain areas so if in the first stage of Hypocorticolism, there are big amount of cortisol, the hippocampus becomes “swollen” from the initial high stress period. Your brain just through multiple mechanisms shuts down your stress response in order to prevent further damage. That is the start of hypocorticolism- and various damage can be done of various tissues in the body. Many people mistakenly think that it starts in the adrenals, but it starts in the brain. You can expect fatique, depression shortness of breath etc.
If you have also high cortisol in the beginning, it disrupts the conversion of T4 to T3 and rT3 goes higher. Hypothalamus sees chronic high cortisol it sends hormones to turn down cortisol release. It also sends messages to your pituitary and thyroid to STOP secreting thyroid hormone because it can’t hande anymore stimulation.
So in fact I do believe that if you have low cortisol (you can do multiple test of saliva cortisol to be sure, it is the most accurate one …) you need to treat it accordingly.
According to you, OP should do nothing about his thyroid and stop trying to become OPTIMAL that is what he needs.
Because i was always having cold feet and it helped me with that. Also my doctor wants TSH as much as close to 1. I had appointment with my doc today and he told me to go back to 100mg a week and take 60mg Armor instead of 30mg. It didn’t make sense to me but according to him high ft3 don’t matter much as long as i dont have hyperthyroid sypmtoms or tsh gone to almost zero. You are right about cortisol, i always had good cortisol level and acth so no adrenal fatigue issue. What do you think of new protocol? Thanks
That B12 is useless. Get something similar to what @dextermorgan is showing you.
You’re going to increase Armor again? I’m really doubting this doc of yours. Taking Armor with already natural high levels of thyroid (off the charts high) doesn’t make sense to me.
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Whats the evidence that he might be suffering from adrenal insufficiency? Morning cortisol and ACTH are fine and as mentioned they have a high negative prediction value. Cortisol treatment, especially for longer periods is not something one does for fun as the risk of developing a real adrenal insufficiency from this is not neglectable.
Salivary cortisol has a sensitivity of only about 35% in diagnosing adrenal insufficiency compared to the golden standard the ACTH stimulation test.
Yes subcl hypothyroidism is associated with increased cortisol levels; there is a positive correlation between TSH and morning cortisol levels.
In critically ill patients (eg after a myocardial infection) an association between high cortisol levels and reduced T4 to T3 conversition plus elevated rT3 was observed, but does this mean causality? Or is the lowered T3 and elevated rT3 rather the effect and not the cause of the shifted metabolic state? The data speaks for the latter.
An animal study demonstrated that after administration of cortisol to otherwise healthy animals resulted in an increased T4 to T3 conversion. This could present a sort of a rescue mechanism; when the output of T4 due to reduced thyroid function is reduced the body increases the T4 to T3 conversion and thereby tries to recover an euthyroid status.
Back to @swan9021
TSH is fine. Cortisol is fine. T3 and T4 were on the lower side initially. If at all, this speaks for a central hypothyroidism. But i doubt that even this is the case. Simply because treatment by T4 or T4/T3 to the point of a mild hyperthyroidism did not improve his symptoms.
Unfortunately i dont know the answer to his problems but I am confident that another round of thyroid medication, TRT optimization or cortisol treatment is not going to fix the problem either.
There are many physiological and psychological causes for the symptoms he describes and after testing the physiological ones by trial and error it might be helpful to invedt some time on latter mentioned causes.
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Another thing came into my mind.
According to studies TRT temporarily increases the T3 to T4 conversion in men. We actually have many men here reporting this observation, myself included.
At the same time TRT has been described to temporarily increase cortisol secretion. Its tempting to speculate that the increased T4 to T3 conversion is due to the elevated cortisol as both observations are occuring simultaeously from a time perspective.
T3 to T4 or T4 to T3?
Thanks @ncsugrad2002, well spotted.
Of course T4 to T3.
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Do you have any recomendation about protocol? I am thinking just to try 34mg EOD for two months and see how i feel. Without taking any thyroid medication. What do you think of that?Also i just ordered same B12 the one @dextermorgan mentioned. Thanks
I apologize but I did not read the entire thread. I saw that you were taking 1mg of Arimidex twice a week and I moved to another thread.
Give me it in a nutshell
Current protocol with all relevent details
Total T and Free T
Symptoms
And why 34mg EOD? What made you choose that out of curiosity?
You seem very knowledgeble, can you please look at my thread (Horrible hormone panel, road to recovery). I haven’t started TRT nor any thyroid medication. I have been slowly weaning off my antidepressants (currently at 5mg of Cipralex). I dont want to hijack this thread, so please look at my thread. Same to @dbossa. Thanks both of you in advance.
I started TRT 4 months ago, never touched Arimidex. First 2 months I was doing 30mg EOD SubQ and my results were after 2 months:
TSH |0.35 - 5| 1.77 mIU/L |NORMAL|
FREE T4 |12 - 22| 17.9 pmol/L |NORMAL|
FREE T3 |3.4 - 5.9| 6.1 pmol/L | HIGH |
T3, REVERSE |9.2 - 24.1| 21.4 ng/dL |NORMAL|
TESTOSTERONE, TOTAL |219 - 904| 585 ng/dL |NORMAL|
TESTOSTERONE, FREE |196 - 636| 569 pmol/L |NORMAL|
SHBG |12 - 60| 19.18 nmol/L |NORMAL|
ESTRADIOL |0 - 43| 36.78 pg/mL |NORMAL|
PROGESTERONE |0 - 0.6| 1.2 nmol/L |HIGH|
DHEA |4.3 - 12.2| 18.6 µmol/L |HIGH|
DIHYDROTESTOSTERONE (DHT)|** |860 - 3406| 3775 PMOL/L |HIGH|
Then I switched to 40mg EOD Subq with addition to 30mg Armor thyroid(always had cold feet) and I just did blood test 1 week ago after two months & results are:
TSH |0.35 - 5| 1.59 mIU/L |NORMAL|
FREE T4 |12 - 22| 16 pmol/L |NORMAL|
FREE T3 |3.4 - 5.9| 7.5 pmol/L | HIGH |
TESTOSTERONE, TOTAL |219 - 904| 829 ng/dL |NORMAL|
TESTOSTERONE, FREE |196 - 636| 866 pmol/L |HIGH|
SHBG |12 - 60| 18.34 nmol/L |NORMAL|
ESTRADIOL |0 - 43| 43.85pg/mL |HIGH|
DHEA |4.3 - 12.2| 14.9 µmol/L |HIGH|
PROGESTERONE |0 - 0.6| 0.9nmol/L |HIGH|
Symptoms:
During both protocols i really didnt feel any difference except hair falling and burning itchy feeling all over body during workout. I still have fatigue, No morning wood, almost no libidio, no senstivity in penis, can’t gow beard and no body hairs, Chest pain, No confident, can’t grow muscle. Now in addition to that getting depress as well becasue i thiught trt would reslove atleast some of the issues.
Now my doc prescribed my 60mg Armor and wants me to go back to 100mg a week. I was thinking to do 34mgEOD because I may have optimal levels and don’t use armor at all. In addition to that I would be using B12. Any advice would be appreciated.
The fact that your doctor is giving you thyroid is, in my opinion, absolutely insane.
If I was a doctor, and you were my patient, I would tell you to stop the thyroid immediately.
140mg a week total is currently getting your total to 866 and free to 25 while taking 40 EOD.
Your best dose is going to be somewhere between 50-60 EOD most likely. You can do one of two things:
-
Increase to 50 EOD and assess after 6 weeks. Increase if you are feeling some improvements but not there yet.
-
Increase to 60 EOD now and see what happens. If no improvement at that dose, testosterone is probably not your problem. If you feel much better at 60, later on you can always try reducing to 50 and see if you feel just as good at a lower dose.
If it was me in that situation, and I’ve been in that situation, I would go with option 2. When I wasn’t getting any benefit I increased to a much higher dose to see what impact it made. Sure enough, I finally started feeling the benefits and I saved a lot of time.
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