Hello everyone,
Very thankful for the wealth of info on T issues here. I read all the stickies and am feeling like there’s hope! I have great insurance so I have been able to get a lot of tests over the last year. Below are the records I have taken at various dates. I clearly need to get my E2 tested again in addition to all the rest. As usual, I saw an Endo and they think my levels are “great!” for a 36 year old guy who has been physically active and eats healthy most of his life.
I am 36yo, 6’1, 210lbs. Train 3 times a week. Eat mostly veg/fruit/meat. Don’t smoke. Drink occasionally. Over the last few years I have been pretty down on myself and life in general. I just figured it was typical. I am now starting to expect more. As careful as I treat my body, I should not have all the issues I have.
Symptoms: social withdrawal, ZERO libido, moody, exhausted in late afternoon, no gains in the gym - just maintaining what I have really, cold all the time - particularly hands/feet, weak/thin skin - bleed/bruise easily, and I just don’t really care about much these days - good or bad. I am just not there emotionally.
My body temp measures in the 95-96 range. I am going to keep testing regularly as that seems REALLY low. I definitely have always been a cold person.
My doc’s eyebrows first got raised when seeing the Bio-T number on 1/24/2018 of 54. It was below the “normal” range. It’s always been towards the low end as you can see in the other numbers. Total has been OK in 2017 but has also dipped. I feel very confident I have a T or thyroid issue after reading all this stuff. Wondering if any of you who are better educated than I am can help confirm or deny this feeling I have by reading this and analyzing the results below. Many thanks for any interest/advice:
Your thyroid labs are inadequate, you need to be checking Reverse T3 as well as the ones tested and Free T3 and Reverse T3 need to be tested together. Only a full thyroid panel will do. Reverse T3 competes for the same receptor and if elevated it will negate Free T3. Your pituitary gland is showing a decline in its ability to secrete LH, you have secondary hypogonadism. Your TSH is all over the place indicating thyroid dysfunction.
Endocrinologists are the worst at diagnosing a testosterone deficiency, their specialty is in diabetes and thyroid disorders, TRT is like a gray area for them and they tend to lack any real knowledge about male hormones. The majority of doctors have no knowledge or training in TRT and will tell you you’re levels look great to get you out of their office.
Your elevated SHBG is making things even worse binding up the majority of your bioavailable testosterone, your endo is unaware of this because he didn’t learn anything about male hormone in medical because it isn’t normally covered. The medical community doesn’t like TRT, they view it as cheating, unhealthy, taboo and still believe it causes cancer.
It is for the reasons mentioned above insurance is all but useless for TRT, most of the doctors stumble when they should be expects in male/female hormones, sadly big pharma is to blame because they don’t view TRT as a profit generator. Viagra, Cialis, depression medications are all patented drugs, hormones cannot be patented therefore it isn’t seen as profitable.
Most of the TRT success stories have sought private care, paying out of pocket.
Thank you @systemlord . I will ask for Reverse T3 when I go back into the doc in 2 weeks. My general practitioner is very open minded. I think she will ultimately put me on some T (she insinuated that it would be a cream, which sounds like it’s not all that efficient from what I read here). Because of the low LH numbers (combined with the low Bio-T), I did get a pituitary MRI. Those results came back “normal.”
Is a “Full Thyroid Panel” something the doc will understand? I have had a few other panels here in case this data might help: Hepatic Function Panel, Basic Metabolic Panel, CBC With Differential, Lipid Panel, COmprehensive Metabolic Panel, Epstein Barr Virus VCA Ab Panel
There aren’t many doctors out there that fully understand thyroid matters within insurance networks, let alone TRT related matters. The fact she mentioned a cream as a first choice is a red flag your doctor is a little behind. Injectable testosterone is 100 percent absorbed, but requires the most skill from doctors.
This is where reading blood biomarkers is key to dosing and injection frequency, gels, creams make it easy for inexperienced doctors. Think of it as training wheels on your first bicycle, it’s easy for the inexperienced rider. The fact that she’s open minded doesn’t help you, you’re going to teach your doctor how to do her job? You need to seek a hormone specialists.
The difference in how you feel on TRT will depend on the doctor, if your hormones aren’t properly balanced you will not feel your best.
Understood. I think there’s another thread with good docs in various states. Hope there’s a Michigan rec! So in your opinion, if I get the below tests, I could come back here and get some good advice on next steps? I just want to make sure I am thorough in what I ask my doc to test in light of everything you said. I pulled htis list from the stickies and then added the suggestions you threw out:
Labs to be done before you start TRT
-LH and FSH [LH/FSH]
-TT
-FT or bio-T
-SHBG
-E2
-Prolactin [optional in most cases]
-DHT [sort of a waste of time and blood if your testosterone levels are low]
-PSA
-T3
-Reverse T3
-Full Thyroid panel
Here’s a complete list of tests needed.
Total T
Free T
SHBG
Estradiol Sensitive (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
Cortisol
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel
Are you on any medications? Intermittent fasting or Keto?
your SHBG is the problem. TRT will help.
@anon10035199 no meds (other than Onnit Krill Oil, Host Defense Lions Mane mushroom pills, Vitamin D). I mostly eat veg/fruit/meat but I will eat a pizza and drink some beer every now and then.
@systemlord I think I am going to try and get in to see Dr John Crisler in Michigan. I live an hour away. Seems like he is at least solid from what I have read here. @KSman seemed to be OK with him so that seems like a good place to start. Any current opinions on Dr Crisler would be appreciated from anyone else here of course.
Lastly, I have tested my temp throughout the past 2 days. I am in the low 97 degrees pretty much all day. Highest was 97.5 last night before bed. Lowest was 97.0 at noon today.
Thank you all again!
I’d look into those mushroom pills. Could be straining your liver, possibly.
Those temperatures aren’t even close, my waking temperatures are higher. Dr John Crisler is a good choice, the guy lays awake at night thinking about your case. Kind of like a theoretical physicist, but hormones and not particles.