Even since I got a varicocele, I’ve had symptoms of subclinical (borderline) hypothyroidism. After doing some research it appears that free T4 is actually more important than T3 for erections. I read a few studies online that resolved libido/ED issues with T4 medication.
My current labs look as follows:
Thyroid
Free T3 - 3.45 ng/L ( 2.1 - 4.4 )
TSH - 0.68 mU/L ( 0.3 - 4.2 )
Total T4 - 0.73ng/dL ( 0.61 - 1.12 )
Total T3 - 1.1 ug/L ( 0.7 - 2 )
Sex Hormones
17 Beta Estradiol - 41 pg/nl ( 10-50 )
Progesterone 0.42 ug/L ( < 0.2 )
Total Testosterone - 5.29 ng/mL ( 2.6 - 10 )
Free Testosterone - 11.7 pg/mL ( 8.3 - 40.1 )
Reverse T3 showed up at 0.26 (range goes up to 0.29 I believe), though this was on a prior test before TRT.
Even though I need to raise T4, I’ve heard that could be counter productive if you have high reverse T3. Would a T4/T3 combo be best or something like NDT/Armour?
T4 converts into rT3. If you add more T4 you’ll get more rT3. To lower rT3 you must increase fT3 without increasing T4. T3 only meds does this. Start at 25mcg and titrate up to where you feel a tad jittery then back off a tad. This will be your sweet spot. Don’t go above 100mcgs.
You need to get your fT3 as close to the top of the range as possible. Everything else thyroid wise looks good.
I would bet money your ED issues are related to your lower free testosterone than anything. Your Estradiol and progesterone are high relative to your testosterone too. That and your lifestyle. Do you drink, smoke and eat like shit? Fix those things and report back.
Really appreciate your insight here! Much appreciated. To give a little feedback, all my issues started due to a varicocele that occurred due to a sports injury.
Over the course of 4 weeks the following symptoms manifested:
My body temp lowered and I became cold intolerant
I lost sensation around my body, that felt like a lack of circulation
I developed digestive issues
My TSH (initially) was hoovering around 2-3 (anything over 1.5 is said to be potentially problematic)
I lost my libido over that 4 week period and all sexual function/sensation
Started getting dry skin and dandruff
Gained weight around mid section and skin felt constantly cold
Starting sweating excessively
My diet is clean (chicken, red meat, veggies, fruits, etc). I don’t smoke nor drink. I have never done anti-depressants, steroids or hair loss pills.
I am currently on test cyp 12.5mg daily and 100iu of HCG (also daily). I’ve been on this for around 5 months now, but seeing no improvement in libido/erections. I wake up with morning wood, which is weird…but I have zero libido.
I have a theory on why my progesterone is high. It’s been noted in varicocele sufferers that progesterone is raised and I believe it’s due to the effect it has on two areas: thermogenic properties (it aids thyroid function) and it also helps with anxiety, vascular health, etc. The main issue is that high progesterone blocks DHT/E2 from functioning properly.
I should also note that at times it feels like I have zero blood flow in my junk, and literally no sensation. The doctor wants to trial me on Proviron daily, but I feel deep down the issue is rooted in thyroid…
My fear with messing with thyroid is making things worse instead of better. Wouldn’t raising free T3 lower FT4 further? and by proxy reduce all thyroid production…
You’re on to something regarding T4 function in the brain. Most with elevated rT3 still need T4 as the brain needs it. The trick is in finding the correct dose of each. If the standard versions (Armour, etc.) do not work, the solution may be in a customized T3/T4 combo.
I’m actually going to get new labs done tomorrow with all the thyroid values so I can see what’s going on in full. The reason I am looking into thyroid is because I have cold intolerance pretty badly and zero libido. I believe I have what could be considered “acute” subclinical hypothyroidism due to low Free T4 levels.
I don’t have recent labs though, so new blood work will be done soon
Varicocele doesn’t affect the thyroid, fT4 is not the active hormone, fT3 and rT3 are the major hormones. Your T4 is pretty low and you can think of T4 as the raw hormone needed to convert to other hormones such as fT4, fT3 and rT3. In other words your gas tank is near empty and you probably don’t have enough raw thyroid hormone to feed the other hormones and what hormones you do have are favoring rT3 robbing you of increases in fT3.
If T4 was any lower, you would be full blown hypothyroid. It seems like sometimes fT4 is low and other times high, this is because T4 is in short supply and your thyroid just can’t produced enough raw hormone consistently. Your FT levels are also part of the problem, your testosterone levels are without a doubt low and your thyroid hormones aren’t helping matters.
Varicocele impacts thyroid due to the thermoregulatory impact it has on the vascular system. That entire area (pampiniform venous plexus) is essentially a heat-exchanger and if issues occur with back flow, the body has to be compensate somehow. I have a strong incline that when overheating (and oxidate stress) occur due to varicocele, the body compensates (or has a fallback mechanism) of cooling down the testicles by lowering overall body temp. Which of course, leads to subclinical (acute) hypothyroidism symptoms…
This may also occur due to testicular damage caused by the oxidative stress.
There is also a lot of literature pointing to TRH receptors in the testicles themselves, which aid in the thyroid feedback loop (which makes sense for sperm regulation).
In relation to ft4 not being the active thyroid, I agree - but it is important and i think one of the biggest red herrings in treatment in thyroid is assuming ft3 is the only hormone needed when T4 receptors exist within the body equally. Also resolution of ED/libido issues all align with raised fT4 levels (which by proxy may be also due to increased fT3 levels).
These labs were taken before I switched my protocol to a higher testosterone dosage and I am going to be starting Proviron soon to further increase DHT (which is probably low) and free up testosterone. With that said, I want to fix thyroid as I believe this is the real culprit of my issues…
I agree with this. If your body doesn’t have a problem with T4->T3 conversion, then there is no reason to supplement T3. I think you are correct to get your blood checked with a full panel, and if your FT4 is still on the low end of the range and FT3 is normal, then adding a little Levothyroxine/synthroid would be a good place to start your protocol.