41 YO Low Thyroid, Low T

Pharma / TRT Testosterone Replacement
1

-Age 41
-Height -5 foot 6
-waist - 35
-weight - 235
-describe body and facial hair â??Full head of hair. I can grow a beard in a little over a week. I have a full chest of hair and some on my back. Very little hair on legs and my lower leg are pretty smooth.

-describe where you carry fat and how changed- Mostly around the gut and man boobs

-health conditions, symptoms
brain fog
Lower Sex Drive
Trouble maintain erections
can’t lose fat for anything
Decrease in energy
Decrease in endurance
Decreased focus in the gym
Lose of strength over last few years.

-Rx and OTC drugs, any hair loss drugs or prostate drugs â?? Never

-describe diet [some create substantial damage with starvation diets] I have been eating more Paleo lately but still have some processed foods.

-describe training [some ruin there hormones by over training] I normally lift 3-4 times a week for around an hour. My strength has really dropped off over the last few years so frequency and duration has decrease as well.

Testes ache, ever, with a fever? Never

-how have morning wood and nocturnal erections changed ? Morning wood very infrequent

Supplements-
Fish oil
Probiotics
Multivitamin
Vitamin d (in winter)
Selenium (started after labs)

=====================================

I was referred to an endocrinologist for an unrelated problem. He ordered a full lab and was concerned about my thyroid and testosterone levels. He said that we would tackle the thyroid problem first since that might help out my test levels. He started my on 125mcg of Synthroid. He warned that I might feel like a fever or a fast heart beat none of which I got. To be honest I canâ??t tell that the pills are doing anything. I have a MRI on my pituitary that showed nothing abnormal.

=====================================

I started taking my temps three times a day. Here are the averages
6:30 -96.32
10:30 â?? 96.87
2:20 â?? 97.32
During the three weeks I have been tracking so far I have never got above 98 degrees.

After reading the forum I started taking 10 drops of Lugolâ??s solution of potassium iodide and iodine. After a week other than an upset stomach I havenâ??t noticed much of a change.

=====================================

LABS â?? I show results when they are listed. I got the results from an online tool to get the result unfortunately most of the results arenâ??t listed. I have an appointment in two weeks and will ask for a printout of the results with ranges.

Sep 02, 2014
Cortisol 26.2mcg/dl, 21.9mcg/dl and 9.7mcg/dl (I took an initial test then took a shot to test cortisol response.)
Range
AM (0700-0900): 6.7-22.6 mcg/dL
PM (1500-1700): 1.0-9.9 mcg/dL

PSA - .57 ng/mL â?? no range given
LH â?? 3.4 milli_International_Units/mL Range 1.8 to 8.6 IU/L.
FSH - 4.4 milli_International_Units/mL 13-70 yrs: 1.2-19.3 mIU/mL
Aug 29, 2014 Labs
PSA 0.61 ng/mL â?? no range given
Anion Gap Results 13 mmol/L
GGT_ Results 27 International_Units/L
Albumin Level_ Results 4.0 g/dL
GFR - African Amer.Factor Results 90 mL/min/1.73m2
Stage 1: Greater than or equal 90; Normal or Minimal Kidney Damage
Stage2: 60 â?? 89; Mild Decrease in Kidney Function
Stage 3: 30 â?? 59; Moderate Decrease in Kidney Function
Stage 4: 15 â?? 29; Severe Decrease in Kidney Function
Stage 5: Less than 15; Kidney Failure
GFR Results 75 mL/min/1.73m2
GFR:
Stage 1: Greater than or equal 90; Normal or Minimal Kidney Damage
Stage2: 60 â?? 89; Mild Decrease in Kidney Function
Stage 3: 30 â?? 59; Moderate Decrease in Kidney Function
Stage 4: 15 â?? 29; Severe Decrease in Kidney Function
Stage 5: Less than 15; Kidney Failure
#Mono - Auto Results 0.44 x10^3/mcL
#NRBC Results 0.00 x10^3/mcL
#Baso - Auto Results 0.03 x10^3/mcL
#Lymp - Auto Results - 1.90 x10^3/mcL
#Eos - Auto Results - 1.81 x10^3/mcL
#Neut - Auto Results 4.10 x10^3/mcL
NURBC Results 0.0 #/100 WBCs
WBC Results 8.24 x10^3/mcL
Chloride Results 103 mEq/L
BUN Results 14 mg/dL
TSH - 5.64 mc_International_Units/mL
Trig Results 74 mg/dL
REFERENCE RANGE:
Borderline High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: >=500 mg/dL
Total Protein Results 7.6 g/dL
T4 Free Results 0.47 ng/dL
T3 Free Results 2.64 pg/mL
Sodium Level Results 143 mEq/L
RDW Results 13.1 %
RBC Results 5.14 x10^6/mcL
Prolactin Results 6.99 ng/mL
Potassium Level Results 4.2 mEq/L
Platelet Results 231 x10^3/mcL
%Neut - Auto Results 49.7%
MPV Results 7.2fL
%Mono - Auto Results 5.3%
MCV Results â?? 86.9fL
MCHC Results â?? 33.5 g/dL
MCV Results â?? 86.9fL
MCHC Results â?? 33.5 g/dL
MCH Results 29.1pg
%Lymph - Auto Results 22.7%
HGB Results â?? 15.0g/dL
HDL Results â?? 22 mg/dL
HCT Results â?? 44.7%
Glucose Level Results â?? 93 mg/dL
%Eos - Auto Results â?? 22.0%
Cortisol Results â?? 7.0 mcg/dL
REFERENCE RANGE:
AM (0700-0900): 6.7-22.6 mcg/dL
PM (1500-1700): 1.0-9.9 mcg/dL

CO2 Content Results â?? 27.0 mmol/L
Chol Results â?? 181 mg/dL
Desirable: Less than 200 mg/dL
Borderline High: 200 â?? 239 mg/dL
High: Greater than or equal to 200 mg/dL

Bili Total Results 0.7 mg/dL
% Baso - Auto Results â?? 0.4%
AST Results 24 International_Units/L
ALT Results 24 International_Units/L
Alk Phos Results - 87 International_Units/L
LDL/HDL Results â?? 6.6
LDL Calc Results - 144 mg/dL
ADULT
Optimal: <100 mg/dL
Near or Above Optimal:100-129 mg/dL
Borderline High: 130-159 mg/dL
High: 160-189 mg/dL
Very High: >=190 mg/dL
Hemoglobin A1C Results â?? 6.0%
Diagnosing Diabetes (ADA): >6.5%

Therapeutic Goals for Glycemic Control (ADA) (Adults):
Goal of Therapy: <7.0% HbA1c
Action Suggested: >8.0% HbA1c
Chol/HDL Results 8.2
Diff Type? Results â?? Auto Diff
Creatinine Results - 1.09 mg/dL
TSH Results - 5.64 mc_International_Units/mL

I have another set of labs in a week followed by another appointment a week after that. Is there something I should ask the endocrinologist?

2

Thyroid numbers a mess. Please read the thyroid basics sticky.

Is your thyroid enlarged, asymmetrical or lumpy? - you can feel yourself for some of that, neck appears thick there?

Were you using iodized salt steadily for years?

Iodine replenishment requires a lot of iodine, see the sticky.

Your doc is correct, thyroid can affect T levels.

Take 5000iu vit-D3 year round, find tiny oil based caps.

Digestive problems?

3

[quote]KSman wrote:
Thyroid numbers a mess. Please read the thyroid basics sticky.

Is your thyroid enlarged, asymmetrical or lumpy? - you can feel yourself for some of that, neck appears thick there?

The endocrinologist spent a while feeling around and said everything felt normal.

Were you using iodized salt steadily for years?

No, we just started using it. And truth be told I don’t use a lot of salt.

Iodine replenishment requires a lot of iodine, see the sticky.

When I started supplementing iodine my stomach didn’t like it. Now that it has been a while I will try upping the dosage.

Your doc is correct, thyroid can affect T levels.

Take 5000iu vit-D3 year round, find tiny oil based caps.

Digestive problems?
Nope.
[/quote]

The doctors office called and they want me to take my labs on Monday so I should have a newer set of labs later next week.

4

That is hardly a response to the points in my post.

Did you read the thyroid basics sticky?

  • fT3 might also be a factor

Your cortisol is also low. What time of day were the labs done? <<<<<<<<<

More labs to consider:

  • rT3 [might be blocking fT3 from entering cells]
  • DHEA-S
  • ferritin [good levels needed for fT4–>fT3 [if low, GI bleed might be a blood loss, can check with occult blood test]
  • thyroid antibody tests <<<<<<<<|>>>>>>>>

HDL is very low: - you seem to be on these now

  • fish oil
  • 5000iu vit-D3
  • high potency B-complex multi vit with trace elements, also iodine and selenium

T4 Free Results 0.47 ng/dL

  • should be near 1.25
    T3 Free Results 2.64 pg/mL
  • should be near 3.3

see: Thyroid function tests - Wikipedia

5

Sorry, I posted them in the quote area.

Is your thyroid enlarged, asymmetrical or lumpy? - you can feel yourself for some of that, neck appears thick there?
The endocrinologist spent a while feeling around and said everything felt normal.

Were you using iodized salt steadily for years?
No, we just started using it. And truth be told I don’t use a lot of salt.

Iodine replenishment requires a lot of iodine, see the sticky.
When I started supplementing iodine my stomach didn’t like it. Now that it has been a while I will try upping the dosage.

Digestive problems?
Nope.

Did you read the thyroid basics sticky?
Yes, but sorry it’s a lot to take in. I will reread it.

Your cortisol is also low. What time of day were the labs done?
The original one was done at 8:30am. The endocrinologist was concerned about it as well so I took a second test where they took a baseline at 8:30(9.7 mcg/dL) I then got a shot that was supposed to raise my cortisol level. I took a second test at 9:15am(21.9 mcg/dL) and a third at 9:45am(26.2 mcg/dL).

6

The ACTH shots can see that the adrenals are responsive to that challenge. The results can show that the adrenals are not broken. We are concerned with finer details than that.

7

Albumin Level_ 4.1 g/dL [3.2-5.5]
TSH 1.00 mc_International_Units/mL [0.34-5.60]
T4 Free 0.85 ng/dL [0.61-1.12]
T3 Free 3.04 pg/mL [2.50-3.90]
LH 2.4 milli_International_Units/mL [1.2-8.6]
FSH 2.6 milli_International_Units/mL [1.2-19.3]
SHBG 44f nMol/L [10-57]
Testoster Tot 277f ng/dL [240-950]
Testoster Free 6.4Lf ng/dL [9-30]

I spoke with the endocrinologist about getting the new tests added but he wouldn’t till we meet so they
will be done before my next appointment. He said that my thyroid numbers were looking better and was going to keep me on
125 mcg of Synthroid.

He said that hopefully my testosterone numbers would improve with my thyroid numbers. I told him that I didn’t feel any different and my body temps were still always low. To my surprisehe recommended a sleep apnea test since it can be a contributor to low T. After filling out the pretest paperwork I feel this is dead end.

8

Your A1C is quite high for someone that isn’t diabetic. It’s definitely something to watch as you may be pre-diabetic if not type 2. It should be 5 or less. It’s an average blood glucose indicator over a 3 month period. Any cheat days will be adding to this number. Stress can also contribute by elevating blood glucose via the stress response.

9

You have secondary hypogonadism. FSH is the better indicator of LH status than LH itself.

Mid range fT3 would be 3.2 and you are 3.04

  • and your body temps are still low
  • apparently, TSH often need to be depressed well below 1.0 to releave symptoms
  • this can contribute to low energy and fatigue, but so will your T levels.

Do not see E2/estradiol labs. But with low FT and high SHBG I suspect that E2 is high. ALT/AST do not explain this expected high E2 level.

SHBG explains relative level of FT vs TT

It is important to have selenium in your diet. Check your multi-vits to see.

A small amount of KAL brand [2%] progesterone cream [amazon] may improve cortisol levels.

A SERM, Nolvadex suggested, Clomid should be avoided*, should increase LH/FSH and T.

  • docs keep prescribing Clomid because it was first and saturates medical literature. But some guys get severe estrogenic sides from Clomid. Nolvadex work as well, same dosing and does not have the side effects that some get from Clomid.
    This can bring some relief. While on a SERM, one should feel better. If not and LH/FSH have not increased, stop**. If LH/FSH do increase but after 6-8 weeks the testes are not delivering useful T levels, you will need TRT.
    ** In this case one can try hCG monotherapy and if that does not work, go to TRT.
10

A quick update since I have an appointment Monday morning. I have gone through close to a bottle of Lugol’s solution and other than some occasionally horrible gas I haven’t noticed a difference. The multivitamin I take contains Selenium but I started supplementing it with 200mg.

I have been using KAL brand [2%] progesterone cream every morning and other than smelling nice I can’t tell a difference.

I took my lab tests yesterday.Here are the results from the hospitals labs. I get the results of what they send out at the appointment.

TSH 0.19 mc_International_Units/mL (0.34-5.60 mc_International_Units/mL)
T4 Free 0.78 ng/dL (0.61-1.12 ng/dL)
T3 Free 2.78 pg/mL (2.50-3.90 pg/mL)
LH 3.5 milli_International_Units/mL (1.2-8.6 milli_International_Units/mL)
FSH 3.8 milli_International_Units/mL (1.2-19.3 mIU/mL)
Ferritin 155.9 ng/mL (23.9-336.2 ng/mL)
Estradiol Level 31 pg/mL (0-47 pg/mL)

I will discuss starting Nolvadex with the doctor on Monday. I need to do something different since I don’t feel any better since I started.

Thanks everyone for your input please let me know if there is anything else I should discuss with the doctor?

11

A few more labs:
TPO Ab 29milli_International_Units/mL (0-99)
TPO Ab Interp <100; Negative
Estrone 55pg/mL (10-60)
Test. Total 562ng/dL (240-950)
Test. Free 12ng/dL (9-30)

12

The doctor said that my labs looked good and didn’t want to change any meds even though I don’t feel any better. So frustrating.

13

You were very estrogen dominant.

After taking the iodine, what are your oral waking and mid-afternoon body temperatures?

14

Sorry, I had a cold and didn’t think my temps would be accurate.

For the last two weeks my averages were
6:30am - 96.75
10:30am - 96.98
2:30pm - 97.25