Hypothyrodism or Hypogonadism? Or Both? Lab Report Included

Pharma / TRT Testosterone Replacement
1

2013: Got some blood work done for no reason (no symptoms)
E2: 15 pg/ml
B12: 192 pg/ml
Total Testosterone: 358.04 ng/DL (range: 249 to 836)
Free test: 9.87 pg/ml (range: 8.6 to 54.6)
Ferretin 78.29 ng/DL
DHEAs: 588 ug/DL

2017 June: Suffering from Erectile Dysfunction for about 1 year so went to a doctor (in New York) and he ordered these tests.
Total Testosterone - 360.3 ng/dl (range: 249 to 836)
Prolactin 15.74 ng/ml (range: 4.04 to 15.2)
Estradiol E2: 16.55 pg/ml (range: 23.8 to 60.7)
FSH 2.4 (range: 1.5 to 12.4)
he recommended no treatment and just prescribed Cialis. Soon after that, I lost my health insurance and didn’t go back to any doctor.

2018 - March: Cialis no longer had effect on me. On a chance, I was traveling to India where it is easy to get all tests done without any prescription. So, I bought the comphrensive package and here is what I learnt:

  • Total Testosterone : 140.4 ng/dl (range: 241 to 827)
  • Free Testosterone: 1.2 pg/ml (range: 12.0 to 40.0)
  • FSH: 1.69 mIU/ml (range: 1.4 to 18.1)
  • LH: 2.58 mIU/ml (range: 1.5 to 9.3)
  • TSH: 5.75 uIU/ml (range: 0.35 to 5.50)
  • T3: 105.1 ng/dl (range: 60.0 to 200)
  • T4: 5.81 ng/dl (range: 4.5 to 12.0)
  • E2: 15.2 pg/ml
  • Prolactin: 12.4 ng/ml (range: 2.1 to 17.7)
    Unfortunately, I never got TSH/T3/T4 tested prior to this.

At this time, my symptoms are:

  1. Reduced energy / some fatigue
  2. Cold hands/feet sometimes
  3. Hair loss and significant thinning (for past 2 years)
  4. Erectile Dysfunction (even Cialis which used to work for 2 days now barely works for an hour or two and sometimes does not work at all even after doubling dosage from 10mg to 20mg)
  5. Slight decline in memory/brain/wit. I feel my brain is a little slow. But nothing terrible.
  6. Eczema on elbow/arms
  7. (in last 3 months) significantly slowed down growth of facial hear/beard. I used to have to shave my face twice a day (I like to be clean shaven) but now I don’t need to shave for 2 days! This happened in last 3 months.

I consulted an endocrine specialist in India. He looked at the reports and said, he thinks it is hypothyroidism and once that’s fixed, it will automatically fix my Low Testosterone. But he asked me to do 2 more tests:

  • Antithyroglobulin antibody : < 6.4 IU/ml (negative)
  • Antimicrosomal antibody: < 0.8 IU/ml (negative)

After these tests, he said, thyroid treatment is NOT required. Instead, we must now figure out whether it is primary hypgonadism or secondary hypogonadism. He wants me to do some ultrasound testing and semen analysis. I’m going to try and get that done ASAP.

He refused to prescribe hypothyrodism medicine now. But I was able to get it with help of a pharmacist friend anyway. I haven’t taken any. Levothyroxine 100mcg is what I have obtained.

Now, I’m thinking:
**1. Start taking Levothyroxine 100mcg (I’m 70 kg, male, 35 yo, 5’10)
** and get re-tested in 6 weeks. **
2. If T levels do not increase, then and then only, look into TRT injections or implants.

2

Please include ranges, not every labs has the same ranges.

You have the testosterone levels of a 90 year old man, most men your age have an average testosterone level of 600+, but I don’t expect your doctor to even know this simple fact. Your thyroid is diseased and am dumbfounded as to why your quack doctors believes your thyroid is fine.

Here in USA most progressive doctors take action when TSH rises above 2.5 uIU/ml, your thyroid labs are not checking free thyroid hormones and your doctor is failing you. You need fT3, rT3, fT4 and antibodies tested, however I seriously doubt you have access to some of those tests.

You can forget about TRT right now because it will not work when other systems are diseased, you’ll feel nothing from TRT and possibly worse as TRT attempts to restore metabolic rates a diseased thyroid will have trouble maintaining pace.

My TSH is .580 uIU/ml and I have no hypothyroid symptoms, you’re at the other end of the spectrum and clearly have symptoms. TSH closer to 1.0 is ideal, hair loss is a common to thyroid disorders, thinning eyebrows, dry skin, cold feet are all the most common.

There is not T4 receptor, fT3 is where the rubber meets the road and is the most important test possible. It makes no difference if T4 or T3 is plentiful if thyroid free hormones are deficient as some percentage of the population doesn’t properly convert fT4 → fT3.

You want a complete picture of what’s going on with your thyroid, get complete labs. It sounds as if these outdated old school (dinosaur) doctors are still using the old thyroid TSH ranges when they used to go up to 10.0 before beginning treatment, it’s absurd as you have all the common symptoms of hypothyroidism and doctors do nothing. Crazy world we live in, huh?

3

Hi - thanks for quick response. I’ve modified my first post and posted ranges where I could.

I agree with you - it matches what I was thinking based on several threads I read on this forum.

  1. First, I should try taking thyroxine to see if that lowers TSH and increases T.
  2. Get re-tested.
  3. And then if T is still low, try HCG and clomid for few weeks.
  4. Get re-tested.
  5. If T is still low, look into TRT testopel implants or test cyp/suston injections.

Does this sound like a reasonable course of action?

I’m going to get the other tests you mentioned (fT3, rT3, fT4 and antibodies tested). I already have T3, T4 results. I already have antibodies tested (mentioned in my first post). But I’ll get rT3 tested and fT3 and fT4 if it is different from what I already have (Total T3 and Total T4).

In addition, I’m also getting semen-analysis (prescribed by endocrine specialist in India) and some sort of ultrasound.

I don’t know if there is any lab test for iodine, selenium deficiency. I will ask them tomorrow. If there is, I’ll get those tested too.

It also seems like you don’t suspect hypogonadism. Endocrine doctor said - Hypogonadism could lead to hypothyroidism and hypothyroidism can lead to hypogonadism. Which one is the root cause? To determine that he asked me to get antibodies tested. As soon as the antibodies came negative, he ruled out hypothyroidism as root cause. He NOW believes TSH is elevated because of hypogonadism. And the next step is to simply determine whether it is primary hypogonadism (hence the ultrasound and semen analysis) or secondary hypogonadism.

4

Your doctor is wrong, hypothyroidism doesn’t cause hypogonadism, it sounds like you need to find a doctor who truly understands thyroid and TRT. Thyroid and testosterone production are two different systems, TSH is secreted by the pituitary and pickup by the thyroid, LH is secreted by the pituitary and pickup by the testicles.

Your testosterone is dreadfully low, a dead man probably has higher levels. Sure once thyroid is up and running smoothly SHBG will rise and TT might rise along with it shrinking your FT is concert, but testosterone will still remain low. Cialis has no effect do to the fact that hypothyroidism slows down every cell in your body.

5

Doctors a complete moron! No free thyroid hormones tested, it’s time to leave this doctor. Most doctors fail at thyroid disorders, thyroid is even more complex than male hormones.

This is a quack doctor.

6

I see. So, you are suggesting I’ve BOTH hypogonadism (to be determined if it’s primary or secondary) AND hypothyroidism (to be determined if it’s due to deficiency of iodine/selenium/zinc or improper functioning of thyroid gland).

7

A resounding YES. Thyroid gland and testicles are separate and operate independent. I promise you your doctor didn’t read this hypogonadism is caused hypothyroidism or viscera, he made it up out of a belief.

8

I’ll get additional lab work done first thing tomorrow and share results. I’m planning to do as many of the following tests as they can do at the lab:

  1. iodine deficiency
  2. selenium deficiency
  3. rT3
  4. fT3
  5. fT4
  6. Semen analysis (as prescribed)
  7. Sonography (as prescribed)
  8. DHT
  9. SHBG
9

Was you E2 labs LS/MS/MS method? Any Other test is invalid and is for females. If so you E2 is quite a bit lower.

10

Estradiol (E2)
Tech.: ECLIA/Cobas e411

I suppose E2 will increase when T increases. With 140.4 total T, there is not much to aromatize. I did take DIM supplement for a month or so recently (its found in brocoli) and that also inhibits some E2 aromatization. I took it before getting any tests done.

11

Correct, I had a level of 119 ng/dL on my second test and estrogen was undetableable. Typically 40mg twice weekly will get guys to midrange or better, my estrogen was still low at this dosage. Increased to 50mg twice weekly and T increased and estrogen followed. 60mg twice weekly saw my estrogen rise to unconfirmable levels.

ECLIA is the female estrogen test, it’s useless for males.

12

40mg , 50mg, 60mg of what?

13

Testosterone cypionate. You might try calcium d-glucarate together with your DIM. One blocks estrogen, the other rids you of it. I use both.

1 Like
14

Aah, ok. Thanks. If I do end-up requiring TRT, I’d probably do Testopel implants.

15

No do not use implants, they can be disastrous! You can’t fine tune treatment, just inject testosterone or you’ll suffer. That’s not an opinion, it’s a fact.

16

Got it. I’ll get further lab work done as recommended by you and the doctor and then share results here. Thanks again for your advise and help.

17

Got additional lab work:
iodine deficiency - they don’t have it
selenium deficiency - don’t have it
rT3 - they don’t have it

fT3 - 1.8 pg/ml (range: 1.4 to 4.4 pg/ml)
fT4 - 1.2 ng/dl (range: 0.8 to 2.0 ng/dl)

Semen analysis - could not get it done

Sonography - done (interesting finding, read on)

DHT - they didn’t have it
SHBG - didn’t have it

Scrotum sonography (doppler) revealed two issues:

  1. Very small cyst. Harmless can be ignored for now.
  2. Varicose veins - basically, blood flows into testicles and then the vein that carry it back are dilated and restrict its free flow. Causing blood to pool and raising temperature of the testes. That supposedly reduces sperm count and testosterone. Today is my last day in India so I’m unable to consult doctors here any further but I’ll investigate this when I get back to New York and get on health insurance. Perhaps this is the cause of hypogonadism? And fixing this (minor surgery) could cure hypogonadism?

Does the following sound like a reasonable treatment plan? :

  1. Hypothyrodism: take levothyroxine 100mcg daily for next several weeks. Also, take iodine/thyroid support vitamin supplements.

  2. Hypogonadism: do nothing for now, until I’m able to get back on health insurance and investigate this varicose-veins.

As such, I have also purchased Clomid, Nolvadex and Dostinex/Cabergoline (lowers prolactin), just in case, but I’m not planning to use it in immediate future.

Do you think I should use Nolvadex or Clomid and Dostinex in-parallel with Levothyroxine?

18

Your fT3 is low and should be midrange or better, fT4 is also low and should be midrange or better. I expect your doctor to spit out the words, “you’re within range” BS. This is where T4 would be useful, it would tell us the total thyroid hormones being produced by your thyroid.

You need to find another doctor, it sounds like this doctor would not know someone was experiencing hypothyroid symptoms even if you showed him labs indicating hypothyroidism.

This doctor is one big failure.

19

Many here have thyroid/iodine and low-T issues. If you do TRT with low thyroid function your body will not be able to meet the restored/increased metabolic demands of normal T levels and one can feel worse in some cases.

TSH should be near 1.0
Thyroid lab ranges are mostly useless and “normal” does not mean normal health. The optimal levels are different. Most doctors are clueless.

Thyroid:

  • feeling cold
  • general hair thinning
  • dry skin, brittle nails
  • feeling tired, stupid and brain fog
  • sparse out eyebrows
  • enlarged thyroid
  • thyroid nodules
    and most of the same symptoms as low T

Need to have your oral body temperatures to evaluate overall thyroid function - see below.

We need your history of using iodized salt and/or vitamins that list iodine. Your thyroid problems could be a simple case of iodine deficiency.

fT3 is low and should be mid-range or better, perhaps 3.2 as the range there is different.

fT3 regulates ATP production by mitochondria inside your cells as part of your body temperature control loop. So body temperatures are a measure of how that is working. ATP is what powers your cells and when thyroid function is low, every cell, tissue organ and hormone regulation system is compromised with systems undermining other systems.

Selenium is very important and if you are introducing more iodine there is a DANGER if you are selenium deficient.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

20

For convenince, here are all my test results - all last week of March, 2018:

  • Total Testosterone : 140.4 ng/dl (range: 241 to 827)
  • Free Testosterone: 1.2 pg/ml (range: 12.0 to 40.0)
  • FSH: 1.69 mIU/ml (range: 1.4 to 18.1)
  • LH: 2.58 mIU/ml (range: 1.5 to 9.3)
  • TSH: 5.75 uIU/ml (range: 0.35 to 5.50)
  • T3: 105.1 ng/dl (range: 60.0 to 200)
  • fT3 - 1.8 pg/ml (range: 1.4 to 4.4 pg/ml)
  • T4: 5.81 ng/dl (range: 4.5 to 12.0)
  • fT4 - 1.2 ng/dl (range: 0.8 to 2.0 ng/dl)
  • E2: 15.2 pg/ml
  • Prolactin: 12.4 ng/ml (range: 2.1 to 17.7)
  • Vitamin D, Vitamin B12 and Iron were close to lowest end of normal range. Others (Iodine, Selenium, Zinc etc) were not tested by the lab.

Iodine and Selenium History:
For past 4 years, I’ve never cooked at home. I usually eat only 1 or 2 meals a day and drink a lot of black coffee. I typically eat chipotle burrito, Chinese take-outs, McDonalds etc. Restaurant food tends to have a lot of salt (sodium) but I’m not sure if it is iodized. I live in New York City. I do not consume dairy as I’m lactose intolerant. So, I am not sure if I’m consuming enough iodine and selenium. I’ve just ordered Thyroid supplements from Amazon - they contain iodine, selenium and ashwagandha etc.

Symptoms:

  • Hair thinning all over my head) started about 2 years ago but worsened significantly over past year.
  • Libido loss also started 2 years ago but Cialis would work. It has worsened so much now that even Cialis no longer works in the past 1 year.
  • Decreased mental/cognitive capacity, like forgetfulness and not being verbal witty anymore also started about 2 years ago
  • Slowed beard/facial hair growth (started 3 months ago). I normally needed to shave twice a day for clean shaven look. Now, it takes 2 days for beard to grow that much. I suppose this particular symptom is related to low T and not hypothyroidism directly.
  • Decreased semen volume - couple of drops only instead of spurts!

Plan of action:

  1. Hypothyroidism:
    Root cause: could be deficiency in iodine, selenium etc. Not sure.
    Treatment:
    → Levothyoxine 100mcg every day (for 8-10 weeks) AND
    → iodine, selenium supplements daily.

  2. Hypogonadism:
    Root cause: could be varicose veins
    Treatment:
    → none for now. First, fix hypothyroidism (above) and after 8 weeks, get all lab work done again and decide on a course of action. Fixing low-thyroid (above) should benefit T to some extent anyway but varicose veins still need to be treated with a minor surgery. I’ll get to that after 8 weeks once thyroid is under control. Might not need TRT if varicose veins turn out to be the root cause for hypogonadism.

Does this sound like a good treatment plan?