Yes no reason to waste time with chlomid. TRT is the most effective way to do this and least amount of symptoms and probably cheaper.
What are you saying about his thyroid and not starting trt? If a man has low thyroid or any thyroid issues, that should be resolved along with TRT or am I misunderstanding what you are saying here.
TRT itself will heal many ailments and issues a man has . men need testosterone. without T we break down and vanish from society.
Always start thyroid and T together. Any other health issues can be resolved as you are on HRT, but I wouldn’t be surprised if those issues get better over time.
I was at 4.5 or something and I did not have this hashimotos. What am I missing here with this suggestion?
His TSH is at 3.5 on 88 mcg LT4. No idea where his TSH was pretreatment but it must have been much higher. Hashimotos is just one potential cause, but whatever the exact problem is, a TSH of 3.5 on LT4 indicates undertreatment.
Clomid doesn’t work. Its just waste of time. Take the plunge or keep guessing.
I started Trt and it didn’t work until I started armor thyroid treatment. Thyroid helps metabolize hormones. I loved hearing that from Eric Serrano. I had a feeling it had some type of effect on T, because T did not work until I got my thyroid in order.
for thyroid the rule of thumb is to get free t3 into the top of range. 3.8 to 4.4 out of 4.4 seems to work. Some even sit a few points above 4.4 and feel great. Its not like you will get an auto immune disorder simply because you went a couple points over the lab range. This is because lab ranges are modified by the lab companies. They base it on the current population. The current population is sicker than they have ever been. Low hormone levels across the board, more toxins in the body. Just look at the t labs. total t was 1500 in 2007, last year it was 1200 +, now its 900 something.
I tried synthetic and 2 grains of synthetic was nothing compared to two grains of armor thyroid. I even tried 4-6 grains ( can’t remember) and that didn’t even put a dent in my fatigue. I got my armor thyroid and it worked right way. no more issues.
Honestly, I suggest you find a new doctor now. No excuses, there are several doctors I can refer you to in the USA and you only need to meet them once.
The fact that your doctor gives t4 only shows me hes stuck in sick care and is happy to prescribe whatever his pharmaceutical rep pushes on him. Intelligent doctors who want to resolve symptoms start with armor thyroid or cytomel (t3 only).
When I goto my dr in a couple weeks I’m going to get my tsh, t3, t4 tested and see before asking for armour
Honestly idk if that’s an issue for me though because my last dr checked my TSH and t3. My t3 was at 3.3 and my tsh was at 3.5. So shouldnt that mean if I’m only taking t4 but my t3 is looking “okay” that my body is doing ok on just taking t4 and I’ll be ok just upping my dose?
3.3 is very low . 3.5 is high TSH. You are prolonging a soliton. Honestly I would never put myself through that. Most good doctors do not need labs again and again. It’s obvious yours is low.
I
Like I said before. T3 top of range. You’re is low. I was at 3.8 and felt like I was dying . Never again.
Are you trying to stay in a state of sickness and prolong a solution? Because you sure
Are making this harder than it needs to be
What I’m saying is. If I increase my dose of levothyroxine, that will decrease my TSH and give me t4, which in turn should give me more t3 correct?
If so, why do I need to switch to armour
This isn’t always the case in a small percentage of people. I would argue some people are on thyroid treatment because they don’t convert free thyroid hormones correctly.
In theory, yes, however a percentage of people don’t convert enough t4 to t3 so adding t3 more directly is more beneficial. I’ve heard something like 15% of those with thyroid issues do better on t3/t4 treatment vs just plain t4
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No its just not the rule of thumb, thats internet blabla but by no means evidence based. You definitely want to avoid getting into the hyperthyroid range. Hyperthyroidism - even mild one is associated with an increased risk of cardiac side effects and a decrease of about 3 years in life expectancy. Feeling great is good, but its just not always the best measure of good treatment. If someone stops smoking cigarettes they feel like crap, would you conclude that they should start again because they felt better before?
More than 95% of cases of elevated TSH are caused by Hashimotos disease, he most likely already has autoimmune disease because his treating physician prescribed him LT4 to get TSH down. Thyroid hormone replacement is not associated with the generation of auto immuno disease - even when going far beyond the ref range.
TSH levels on LT4 treatment because of thyroid disease must be viewed differently than TSH levels without any evidence of thyroid disease.
No, lab ranges are not intentionally modified by lab companies. Lab ranges didnt change because T got lower and lower, they changed because just every lab used different methods and different ranges and now its at least a bit more aligned. Just go and read the article from Morgentaler 2007 (doi: 10.1111/j.1743-6109.2006.00334.x), and at least try to understand
‘Of the 25 labs, there were 17 and 13 different sets of reference values for total and free testosterone, respectively. The low reference value for total testosterone ranged from 130 to 450 ng/dL (350% difference), and the upper value ranged from 486 to 1,593 ng/dL (325% difference).’
Not sure if the population in general is sicker at the moment. We have the highest life expectancy that we ever had during the entire history of the human race. We as a population might be sicker, but that’s because primarily because people life a sedentary life style, they eat crappy fast food and get fat. Obesity rates and the consequent life style mediated disease have spread on an enormous rate in the last decades. Thats the problem. I give you one example from a very well desgined study comparing T levels of two different populations; one from around 1990 and one from around 2000 (Platz et al, 2020, doi: 10.1210/js.2019-00151)
What you can easily see, is that young, lean and healthy men had absolutely the same T levels in 1990 than in 2000. On a population levels, T declined, but thats because even young men were getting fat and developed diseases, the proportion of obese and sick people increased, thats what caused the drop in T on a population level.
And T ref ranges as well as thyroid ref ranges are established on a healthy population, not on a sick population.
Depending on your initial TSH and your status of your thyroid, your thyroid is still pumping out some T3. So your situation is completely different to the situation of somebody whos thyroid was removed due to eg cancer.
Yes, as you increase T4 your T3 will also increase. But as mentioned before, some 15% dont convert T4 to T3 properly and thats why they need T3 in addition.
T3/T4 combo therapy is a bit more tricky to use because T3 has a very short half life and needs to be taken 3 times per day. So what you want to do, is to find out if you improve and your symptoms subside by increasing T4 to a proper dose, thats what you are doing now. But thats also something you want to discuss with your treating physician.
And if you dont improve than talk to you doc about switching to T3T4 combo.
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What are you defining as hyperthyroid that once there results in 3 years of life lost? How long at this hyperthyroid state does it take to reduce your life by 3 years?
‘The debate has arisen from studies indicating that not only thyroid disease but also variations in thyroid function within the reference ranges can contribute to the occurrence of chronic conditions and deaths [11,13–15]. Prospective investigations in euthyroid individuals have suggested that high–normal thyroid function increases the risk of CVD, cancer, or CKD, whereas low–normal thyroid function has been associated with an increased risk of chronic metabolic diseases, such as diabetes [11,14–19]. Based on this evidence, it is challenging to determine the balance of overall benefits and risks for specific cutoffs of TSH and FT4 levels within the reference ranges [20,21].
Previous studies have suggested that the beneficial effects of high–normal thyroid function on metabolism can be counterbalanced by detrimental effects on other systems, such as the cardiovascular system [13,18,19,22]. In this context, our study sheds light on the resultant system-specific effects of thyroid function, suggesting that the overall risk of NCD increases in the high–normal range of FT4 levels. However, the LE estimates not only are attributable to the risk of developing the diseases but also depend on mortality risk. Similar to previous studies conducted in middle-aged and older adults, we showed that high–normal thyroid function is associated with an increased risk of mortality [22,37,38].’
I cannot believe so many variable opinions in this thread.
Many people feel crappy on clomid no matter the testosterone numbers. Stop with this lab centric focus. Numbers do not always mean symptom resolution.
You should probably try HCG mono or TRT
I had similar experience with clomid. Testosterone started to go up, but I felt worse than ever
The majority of people have this issue. T4 doesn’t convert. Just ask any doctor.
This is where I get my info. Scott Howell. He has spent his adult life studying anabolics and is an expert in extrapolating data from medical studies and literature. He trains and teaches a phd course (I believe) and is a research animal. The man has clarified many times , along with doctor Nichols and others how and why the labs have dropped.
Pre 2007 the T total was 1500 max, then 1200 and now 900s. This is because its based on a population of unhealthy men.
Just watch this video if you are willing to listen to someone who really knows what they are talking about. Let me know what you think about it.
I dont know about you , but he clearly explains the issues at hand with lab ranges.
Just because it’s being clearly explained doesn’t make it right.
Johan literally said that was internet blah blah blah and your response was a video off YouTube, haha. Come on. At least post real evidence if you believe he’s wrong.
Be open minded. You certainly wouldn’t accept a YouTube video as evidence if you were on the other side of this argument.
Are you saying the studies he’s posted are just a lie? That the standardization effort was a government conspiracy to lower T levels everywhere? Neither of those sound too reasonable to me. I know Nichols pushes this idea and honestly I don’t really care, he’s good at what he does, but that doesn’t in and of itself mean he’s right about everything.
Personally I think it’s a bit of both actual decreases from our lifestyles and the standardization of the ranges, but I don’t claim to have any proof of that.
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I watched the video and its a great piece of (intended?) misinformation. Its a sales pitch.
Just some examples:
min 27:30: Howell: If you talk about being a researching, where did you earn your PhD? What was your thesis topic on?, How many studies do you have indexed on Pubmed?
Thats an interesting point. I looked both up in Pubmed and Research Gate. E.g. Howell has published 11 articels in peer-reviewed scientific journals. Out of those 11, only 2 are first authorships and not a single one is primary research; its all review articles. The two articles having him listed as first authors have an impact factor of around 3.
https://www.researchgate.net/profile/Scott_Howell5/publications
https://orcid.org/0000-0001-6838-1805
Just as a comparison, without trying to come across arrogant, but trying this set this into context. I published my PhD thesis in an journal called ‘Cell’ which has an impact factor of 32. I now have 29 articles in peer-reviewed journal listed on Pubmed with an average impact factor of 11. All, except 3 articles are primary research articles (meaning generating new data by actually doing experiments) and in 17 out of the 29 I am listed as first author.
I couldnt find a single publication in a peer-review journal of Nichols.
https://orcid.org/0000-0001-6400-8931
Regarding the publications shown on the slide min 27: Will be looking out for them, so far nothing published.
Regaring the type 3 hypogonadism, that certainly an interesting thought. Looking forward to reading it once its bein published. But i guess it will be very hard for them to publish in a good journal, because what they lack is hard scientific data.
Regarding EDCs: Interesting theory, its been out in the scientific community for some time. The problem that I have with this is, thats its a theory so far. What I really dont like is that its been used to explain the ‘lower T’ levels of todays young men. In reality the problem in young men today starts much earlier, it starts in children before they hit puberty and before T can play any role.
Look at the graph below from the CDC. In the 70 to 80s about 5% of 6-11 year old children were obese, now its hitting almost 20%. Thats no just overweight, thats obesity for crying out loud and its in these children by no means whatsoever related to testosterone. THATs the reason why so many young men struggle today with diseases which normally only show up in 60 year old men. And thats the reason why so many young men today struggle with low T symptoms. Again, in this age group testosterone doesnt play a role in maintaining a healthy body composition!
min 50:45 regarding the T ref ranges: He is citing the Morgentaler 2007 study. The study demonstrated a wide range in T ref ranges. The upper ref range differed between the labs differed from 486 to 1,593 ng/dL. Only a single lab of the 25 labs had the upper level set at 1593 ng/dl. So why did he select the 1593 ng/dl to go on and make the arguemnt that T levels must have declined because the new range range ends in the 900s? Why didnt he select the 486 ng/dl, or the average of all upper levels and compare it to the latest upper level? He would come to a conclusion that T levels may actually have increased? The answer is two-fold i) he uses it intentionally to make a sales pitch and ii) he may not actually understand because he lacks a training in analytical biochemistry.
He goes on discussing the paper from Travis et al 2007, ‘A population-level decline in serum testosterone levels in American men’. Again he just picks out what he wants to sell. No limitations of the study and certainly he doesnt mentioned that another study using actually more sophisticated analytical technology came to the conslusion that in this period of time no decline in T could be observed in young healthy men.
Go to this post to read more on this comparison between the studies.
min 56:00 regarding morning measurement: No, ‘they’ do not want to limit the access to treatment, ‘they’ just want to assure that there is a standardized procedure inplace that’s why you get tested this way
I stopped watching at min 58 because its a waste of time.
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You do realize they are in the business of providing men HRT and are not a clinic. I do not see any clinics and doctors besides a select few who actually produce information helping men understand TRT. They are the only doctors who actually use studies and literatures to come up with their treatment/therapies. Serrano and a few others do as well.
Why are you always so skeptical? Do you think they are a high volume clinic that needs 20 patients a day to meet quota? You are not giving benefit of the doubt and shooting down someone who knows much more than you on this subject.
You talk about citations/author on studies. The point was that the majority of the people on the internet talking about hormones have zero education on the subject, do not know how to read studies, and should stop making stupid comments that harm people. Hes correct. I see all types of horrible suggestions when it comes to Hormones on forums and YouTube.
Obviously you understand studies and can hold your own, but you really do not have much experience in the field of HRT like these guys do. My belief is that id rather believe the knowledge coming from someone who reads studies and practices the therapies being discussed. Real world data and literature.
Howell is correct when he says he knows more than 99% of the professionals out there. Or is his education not not valid because its a sales pitch?
yes they run a business. Whats wrong with telling people what they do? The fact is they do not manipulate data. They have experience managing HRT for men/women and they merge their experience with the literature and studies they find. You dont even work in the field and have zero experience managing a man or woman HRT. Yet you critique them like they have no clue what they are talking about. Very arrogant.
You go into every conversation and rip it apart by thinking “how can I rip this apart and argue/debate this comment”. I get it, you know your field. I do not, but I do use common sense. Men have lower T today (for whatever reason or reasons) than they did decades ago. Todays lab ranges should not be so low period. There is no way 1 NG/DL is now .7 ng/dl because of more accurate testing. Thats unheard of. How many men have taken labs recently and seen a big decline in total and free t due to this change? I know a few men who have been taking T for years and recently were told they need to lower their T because its above range. How often do we see guys on this forum complaining “im taking the same dose, but now my T levels are 30% lower. I was 1500 now im 1000. Whats wrong?” Its not happening because these tests are not showing such a big variance as you eluded to. Yes I can see them being more accurate and less faulty, but not 30% across the board. No way.
Here is the basic point. Regardless of lab ranges and what lab corp does, we need to treat our symptoms and not ranges. Only sick care doctors treat lab ranges.
If a man feels healthy at 200mg for many years, you don’t go change that 200 to 150 because the lab shows its above range. We can talk about studies and shit later, the fact is this is happening and it’s not fair to men.
I agree about obesity and thats exactly my point. Having low t today is an increasing problem with men and even women (general hormones). We should all be thanking them for doing the work and trying to change the health communities stance on TRT. Thats all they are trying to do. To shoot form the hip and act like they have nothing good to say, because you know it all, is very arrogant and biased. You saying they are biased because they own a business is very unethical.
If you want to see someone who is having a trt sales pitch, go watch the idiot over at the YouTube channel of “live like a viking”. What hes saying is unethical and totally false. Simply to grab more users. he confirms their bias and never confirms the truth. The man says shit like "estrogen causes cancer’ or "estrogen will give you gynecomastia’ or “high estrogen will make you lose libido”.
I do not see any other doctors , on the side of men/women, trying to make big changes in the field of HRT. Name one doctor who is trying to get the truth out about TRT to the community? Thats their end goal. They want men to have easy access to T when they have low t values. They want cardiologists to realize that T is cardio protective. Urologists to realize it does not cause prostate cancer. You do not have to make a man suffer due to prostate issues. T does not inflame the prostate. Plenty of Uro’s are starting to realize this and speak on the subject. There are so many more benefits. I hope one day the medical community stops handing out SSRI’s, statins, anxiety pills and instead treats the root cause for the majority of the issues out there (hormones/diet/ life style).
EDC’s are written about all over the endocrine societies website. Sure we can call it a theory, but what else (besides obesity) is causing it. Not every man who walks into a clinic is obese with low t. Plenty of young and lean 20 somethings are walking into clinics today. The issue here is you are skeptical. You consider yourself this expert on TRT, yet you do not prescribe nor work in the field. Yet you do not want to hear any HRT doctors/researchers point of view.
If I can get you on a video with them. I would love to see you converse with Howell on this subject via a YouTube video. I can make it happen or at least try. Why dont you email them and get a convo started to see if what they are saying makes sense. Im just a laymen, and I cannot debate this subject as well as you can. FFS people believe you over me simply because you know studies. The problem here is that you take a very skeptical approach to everything, yet you reference everything as well.
But what really makes me believe them over you is the fact that they want to help. They are looking to dispel the myths of HRT.
I understand what you mean by the assays, but you also are not taking into consideration the other study he wrote that we have a decline in levels. If we have a drop in levels, and base our lab ranges on a snapshot of todays men. Then we are going to see lower levels. There is now way you can tell me that its all assays that cause such a huge drop in top of lab ranges. Including the low. It just does not make sense to me. There are two variables here. Real mens T lab values and the tests being used. The new lab ranges are based on a snap shot of men , along with that we can say assays are more accurate so the testing will be a little different, but to say that lab ranges dropped only because the testing changed is very short sighted in my humble opinion.
There is no way that 1500 in 2007 is now 900 ng/dl today because of a different test. No way. NG/DL is NG/DL. yes I can see how they could be more accurate, but seeing a 30% decline in testing T from one test to another is not accurate. The fact is that the population of men today are having many more health issues than in the past. One of the theories is EDC’s, and that comes from diet, air pollution, work place pollution and more. They are trying to answer why so many men are having so many issues with T today. Its not because of new testing. You said it yourself. You mentioned obesity.
Maybe you can look at what they are saying with an open mind and not a brain that thinks everyone is out for the almighty dollar. Maybe, just maybe, what they are doing is going to help you with your trt for decades to come. Your kids, my kids, society as a whole. Maybe more doctors will prescribe T when a man has cardio issues instead of making it worse with pharmaceuticals. Maybe SSRI’s will be dropped for those with low thyroid and hormones.
Lets hope.
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