Need Advice

Pharma TRT
21

I ended up dropping the dose back down to 25mg/ED and decided I will try a taper off. The reason I switched from HCG monotherapy to Clomid is because I want to see if I can successfully restart my HPTA. My urologist and I were both hopeful given my MRI scan of my pituitary came back clear, indicating my pituitary gland was functional.

I kind of have a theory though that I just thought of yesterday… Tell me if you think this makes sense:
-Everytime I did an AAS cycle (which was only a few times), after PCT I would always crash. Even 5-6 months later, my T levels would still be low and LH and FSH would be around 1.
-HCG works fine, but Clomid does not work well. Therefore, something must be preventing my pituitary to release enough LH to increase T levels.
-Looking at all my bloodwork, my prolactin levels are always on the high end (albeit in range).
-If my knowledge is correct, prolactin can inhibit LH
-I have developed gyno in my late teens, perhaps that was due to prolactin?
-A prolactinoma has already been ruled out (through MRI) and if I did have one, it is likely my levels would be much higher
-If my knowledge is correct, another cause for elevated prolactin is primary hypothyroidism or secondary hyperthyroidism (basically high TSH).
-My TSH on average has always been above 3.0. The lowest its ever been is 2.35, and the highest it’s ever been was 5.69.

Could it be possible that I have a mild case of hypothyroidism which is causing slightly elevated prolactin that is inhibiting LH? One would think that in a normal functioning individual, clomid should boost LH to the high end of the range, yet for me, my LH is only at 2.

I definitely think I’m on to something but need some advice. I am always freezing cold in the morning, but most evenings I get pretty warm and almost get hot flashes before bed. I took my morning temperature today and it was 36.3 C (97.34 F). This seems a little low to me.

Also note: both my mother and grandfather are on Synthroid for hypothyroidism, so I’m not sure if it could run in my family, or maybe I have an iodine deficiency.

22

I was wanting to know LH/FSH while on SERM. Always need FSH.

97.7 waking temperature is pretty decent. Keep checking and also mid afternoon should be 98.6F 37C

Focus on thyroid: read thyroid basics sticky

23

[quote]KSman wrote:
I was wanting to know LH/FSH while on SERM. Always need FSH.

97.7 waking temperature is pretty decent. Keep checking and also mid afternoon should be 98.6F 37C

Focus on thyroid: read thyroid basics sticky[/quote]

What I am curious though, is why my LH and FSH are still pretty low after all that time on Clomid? It seems like there is an underlying issue that is preventing Clomid from being effective.

Here is an interesting abstract that makes me further suspect a thyroid issue: The interrelationships between thyroid dysfunction and hypogonadism in men and boys - PubMed

My understanding is that primary hypothyroidism supposedly lessons the pituitary response to GnRH. My understanding of how Clomid works is that it boosts GnRH by blocking estrogen from binding to receptors, and the hypothalamus receives negative feedback. If this theory is correct, one who has secondary hypogonadism with primary hypothyroidism should not expect much of an increase in LH and/or FSH (similar to my situation).

On the other hand, HCG seems to effectively boost T levels in those with primary hypothyroidism since it bypasses the pituitary. I know from experience, that once I was dialed in on my HCG dose (250 IU/EOD) I felt great.

I have this odd thought that by supplementing with Synthroid, my LH will increase and so will my T levels with or without Clomid. I’m going to get a thyroid panel next week. I’m going to ask for TSH, FT3, FT4 and rT3. I’ve had thyroid panels done in the past with very whacky results (high TSH with normal-low FT3 and FT4, high TSH with normal-high FT3 and FT4, slightly high TSH with normal FT3 and FT4), but never had a doctor willing to look into it for me. I had all anti-bodies checked, and that came back clear.

Any thoughts?

24

BUMP

Could I be on to something here?

25

Guys, I really need some help. Here’s more bloodwork:

October 2014:
LH: 2 IU/L (ref: 1-9)
FSH: 2 IU/L (ref: 1-19)
Estradiol: <37 pmol/L (ref: 40-160)
Total Testosterone: 13.0 nmol/L (ref: 6.1-27.1)
Free Testosterone: 233 pmol/L (ref: 110-660)
Bioavailable Testosterone: 5.5 nmol/L (ref: 2.8-15.5)
SHBG: 40 nmol/L (ref: 13-89)

TSH: 2.94 mU/L (ref: 0.3-5.60)
FT4: 10.7 pmol/L (ref: 7.0-17.0)
FT3: 4.0 pmol/L (ref: 3.3-6.0)

I feel like shit, always cold, brain fog, fatigue. And get this, my Urologist didn’t think my Testosterone levels were all that low, and he then says my Estradiol is undetectable which is good. HOW IS THAT GOOD? What are the dangers of my low Estradiol? Also, my thyroid panel looks terrible. I suspect adrenal fatigue, but haven’t gotten Cortisol tested. I started taking an adaptogen, B vitamins, and Magnesium, and switched my diet, and my temperatures are improving now (they were averaging 35.5 C per day, and now average around 36.5 C). But I am still very fatigued, low libido, and low energy. I sleep a lot, but never feel refreshed. I usually have to pee once in the middle of the night.

HELP!

26

Estradiol: <37 pmol/L (ref: 40-160)
Yes, that is low. However that is the result that you can also get via a lab error and we have seen that several times.

TSH: 2.94 mU/L (ref: 0.3-5.60)
FT4: 10.7 pmol/L (ref: 7.0-17.0)
FT3: 4.0 pmol/L (ref: 3.3-6.0)

TSH should be near 1.0, there is something wrong
fT4 should be near mid range = 12.0, 10.7 can cause problems
fT3 should be near midrange = 4.65, 4.0 is also an issue
“I feel like shit, always cold”

Body temperatures? afternoon? You feel cold. What have you been doing to improve thyroid? Iodine?

The LH/FSH labs are with clomid? If so, the top end of the HPTA seems broken and a HPTA restart then is a no-go and hCG or T is needed. HOWEVER, you need to see what your systems can do when thyroid status and body temps are all good. Perhaps the top end of the HPTA is compromised by thyroid issues and that is a common issue. Focus on thyroid and iodine issues.

Because body temp is low and fT3 is low, problem might not be elevated rT3

Have you done research on hypothyroid symptoms? Some are in the thyroid basics sticky.

27

[quote]KSman wrote:
Estradiol: <37 pmol/L (ref: 40-160)
Yes, that is low. However that is the result that you can also get via a lab error and we have seen that several times.

TSH: 2.94 mU/L (ref: 0.3-5.60)
FT4: 10.7 pmol/L (ref: 7.0-17.0)
FT3: 4.0 pmol/L (ref: 3.3-6.0)

TSH should be near 1.0, there is something wrong
fT4 should be near mid range = 12.0, 10.7 can cause problems
fT3 should be near midrange = 4.65, 4.0 is also an issue
“I feel like shit, always cold”

Body temperatures? afternoon? You feel cold. What have you been doing to improve thyroid? Iodine?

The LH/FSH labs are with clomid? If so, the top end of the HPTA seems broken and a HPTA restart then is a no-go and hCG or T is needed. HOWEVER, you need to see what your systems can do when thyroid status and body temps are all good. Perhaps the top end of the HPTA is compromised by thyroid issues and that is a common issue. Focus on thyroid and iodine issues.

Because body temp is low and fT3 is low, problem might not be elevated rT3

Have you done research on hypothyroid symptoms? Some are in the thyroid basics sticky.

[/quote]

Thanks for the fast reply!

I’ve been suspicious of a thyroid issue for years now. It seems to run in my family, but results have been all over the place. TSH has always been above 2, but my FT4 and FT3 have fluctuated so much over the years. Sometimes it’s at the high end of the range, sometimes midrange, and most recently low end of range.

As for body temperatures, on Monday, my waking morning temperature was 35.5 C. Yesterday it was 36.0 C, and this morning was 36.3 I believe. Last week, it was around 35.2 C in the afternoon, and this week I’m getting closer to 37 so far as the day goes on (which is a good sign).

I started Rhodiola Rosea at 500mg per day, B complex, Vitamin C @ 1000mg per day, and Magnesium 300mg per day on Monday. I also stopped drinking coffee, and stopped drinking ice water (I drink warm lemon water). And since I started all this a few days ago, my temperatures have improved. I have been adding iodized salt to my eggs as well, but haven’t been tracking how much iodine. Although my temperatures have improved, I still feel very fatigued, and have brain fog. I’ve been experiencing headaches (probably due to the caffeine withdrawal). I’ve taken time off all activities, and am eating 3 meals per day (protein, healthy fats, fruits/veggies, nuts, and some complex carbs).

As for Clomid, I’ve been tapering off. I was on 12.5 mg/EOD when I had the blood drawn. My previous bloodwork was on 25 mg/ED, so my T levels did drop somewhat, but LH and FSH has been stuck at 2 since Clomid treatment.

If you don’t suspect high rT3 levels (unfortunately my doctor refused to check this) then it’s likely a thyroid problem and not adrenal fatigue? If I knew, it would save me a lot of money because I was planning on getting the 4x Cortisol/DHEA-S test this week, and insurance won’t cover the test.

28

Sometimes we have clear-cut rT3 indications. In your case, not, but maybe something with rT3 is happening that does not fit the typical pattern. There are situations where cortisol problems lead to erratic body temperature fluctuations. But I can’t speak further on that, not familiar enough.

29

Here are some temperatures I logged:

Oct 17:
9:00 AM - 35.2 C
12:00 PM - 35.1 C
3:00 PM - 36.9 C

Oct 18:
12:00 PM - 35.9 C
3:00 PM - 36.5 C

Oct 19:
8:00 AM - 36.2 C
12:00 PM - 36.0 C

Oct 20:
6:00 AM (waking) - 35.7 C

Started Rhodiola Rosea, B complex, Vitamin C and Magnesium.

Oct 21:
6:00 AM (waking) - 36.3 C
9:00 AM - 36.7 C
12:00 PM - 36.4 C
3:00 PM - 36.6 C

Oct 22:
6:00 AM (waking) - 36.0 C
9:00 AM - 36.8 C
12:00 PM - 36.6 C

Oct 23:
6:00 AM (waking) - 36.2 C

30

So I saw a Naturopath, and she definitely agrees based on my bloodwork that my Thyroid and Gonadal function is compromised. She believes the Thyroid dysfunction is likely due to an iodine deficiency. And she agreed that it’s possible the “hypothyroid” is causing my hypogonadism. She also performed a few tests which suggested I have problems with my adrenals. (I have hypotension, orthostatic hypotension, and I failed the iris/light test). So I have taken home the 4x saliva Cortisol/DHEA-S test.

She recommended I buy the seaweed sheets from the grocery store to increase my iodine intake. However, I am just reading about Lugol’s Solution (iodine drops). I’ve been reading about heavy metal toxicity (like bromine, chlorine, fluorine) and it’s relationship to iodine deficiency. I am just wondering KSMan, if you are aware of the Lugol’s Solution or anything else that is highly potent in iodine that I could take to help with my Thyroid function? Also, if there is a protocol in affect to help my Thyroid retain enough iodine, in addition to detoxing (i.e. how much iodine do I need? Supplement with Selenium, Vitamin C, B Vitamins, etc.)

31

Have you studied the thyroid basics sticky?

32

Yes.

33

I bought a liquid Iodine solution which I believe is similar to Lugol’s Iodine. It has 640mcg of iodine per drop. I started yesterday at 2 drops (1.28mg), and today bumped it to 4 drops (2.56mg). I guess I will keep raising the dose by about 2 drops per day until I reach a high enough dose without problems.

So based on the sticky, you said it takes about 0.75g to saturate the body with enough iodine for proper thyroid function assuming the patient is deficient? So I guess if I worked my dose up to about 15mg, it would take about 50 days to reach this state?

I’ll continue to monitor how I feel and take morning temps.

34

My morning temperature has actually been falling since I started the Iodine.

On Monday it was 36.3 C, and today it was 35.8 C. I’m currently up to 10mg of Iodine. No side effects, but still feel lousy.

35

Update:

Continuing with the Iodine, but back on HCG now @ 500 IU EOD. It’s helping my libido and my mood, but I seem to have symptoms of adrenal fatigue.

I was really hoping to be successful with an HPTA restart, but for now I’m fine with HCG if it makes me feel better. I realised something though. Since HCG works, we’ve ruled out testicular failure/damage, therefore the hypogonadism is secondary/tertiary. There is the possibility that clomid failed to increase my GnRH which resulted in continued low LH/FSH, or clomid did increase my GnRH, but the pituitary failed to increase LH/FSH output. Wouldn’t I need a GnRH stimulation test to rule out if the problem is with the hypothalamus or pituitary? If my pituitary is functioning, would I be a candidate for Triptorelin or a GnRH analog? (Single dose of triptorelin gets bodybuilder's hormones going again)

Is it possible that maybe I just responded inadequately to clomid, and perhaps I should try nolva for a restart? Has anyone heard of this occurring?

I am very determined to restart my HPTA, but also afraid of coming off HCG since I always crash.

36

Results from my ASI (Adrenal Stress Index) just came in:

Cortisol:
06:00 - 08:00 AM: 13 (13-24 nM) NORMAL
11:00 - 1:00 PM: 7 (5-10 nM) NORMAL
04:00 - 05:00 PM: 3 (3-8 nM) NORMAL
10:00 - Midnight: 1 (1-4 nM) NORMAL
Cortisol Load: 24 (22-46 nM)

DHEA: 8 (3-10ng/ml) NORMAL

Insulin:
Fasting: <3 (3-12 uIU/mL)
Non-Fasting: 3 (5-20 uIU/mL) DEPRESSED

17-OH Progesterone: 35 (22-100 pg/ml) NORMAL

Total Salivary SIgA: 5 (10-20 mg/dL) BORDERLINE LOW

Gliadin Ab, SIgA: 3 (Positive: >15 U/ml) NEGATIVE

37

So I got a new thermometer and my morning temp is 36.9 C. Not sure if it is accurate. My old thermometer usually reads 36.3 C at that time.

The thing is, even if I am getting very close to 37 C, I still feel cold most of the time, and always have cold hands and feet. Is it possible to have a thyroid issue even with normal temps?

38

"Is it possible to have a thyroid issue even with normal temps?

Perhaps, but the cause is then probably not a lack of fT3 getting into the cells.

You also need to have an identifiable source of selenium when taking iodine. multi-vits!

When on a SERM for a while, you can test LH/FSH levels to see what the top end of the HPTA is doing.

39

I have been supplementing with 200mcg of Selenium along with the Iodine. I also estimate I get about 100mcg of Selenium in my diet. I went for comprehensive bloodwork. Should have the results back this week or early next week and I will post them.

Finally have an appointment with an endo in a month.

40

Got some bloodwork. This is back on HCG @ 250 IU EOD and taking iodine:

WBC: 5.4 x10^9/L (ref: 3.5-10.5)
RBC: 5.33 x10^12/L (ref: 4.00-5.50)
HGB: 163 g/L (ref: 125-170)
HCT: 0.470 L/L (ref: 0.380-0.500)
MCV: 88.2 fL (ref: 80.0-100.0)
MCH: 30.6 pg (ref: 27.0-34.0)
MCHC: 347 g/L (ref: 315-355)
RDW: 12.2 % (ref 11.5-15.5)
Plat: 197 x10^9/L (ref 130-380)
MPV: 9.2 fL (ref 9.0-14.0)
Neutrophil: 3.1 x10^9/L (ref: 2.0-7.5)
Immature Granulocyte: 0.0 x10^9/L (ref: <=0.1)
Lymphocyte: 1.6 x10^9/L (ref: 0.8-3.5)
Monocyte: 0.4 x10^9/L (ref: 0.1-1.0)
Eosinophil: 0.2 x10^9/L (ref: 0.0-0.5)
Basophil: 0.0 (ref: 0.0-0.1)
ESR: 1 mm/hr (ref: 0-6)
Na: 141 mmol/L (ref: 136-145)
K: 3.9 mmol/L (ref: 3.5-5.1)
Cl: 106 mmol/L (ref: 98-107)
CO2: 31 mmol/L (ref: 21-32)
Anion Gap: 4 mmol/L (ref: 5-12) LOW
HbA1C: 4.9 % (ref: 4.8-6.0)

Creatinine: 100 umol/L (ref: 49-93) HIGH
eGFR (MDRD): >60 mL/min (ref: >=60)
Albumin: 44 g/L (ref: 34-46)
Bilirubin Total: 7 umol/L (ref: 3-17)
AST: 12 U/L (ref: 15-37) LOW
ALT: 16 U/L (ref: 17-63) LOW
ALP: 70 U/L (ref: 50-136)
Ferritin: 68 ug/L (ref: 24-336)
Vitamin B12: 348 pmol/L (ref: 133-675)
CK: 103 U/L (ref: 30-250)

Cortisol (AM): 429 nmol/L (ref: 185-624)
LH: <1 IU/L (ref: 1-9)
FSH: <1 IU/L (ref: 1-19)
Estradiol: 72 pmol/L (ref: 40-160)
Total Testosterone: 15.5 nmol/L (ref: 6.1-27.1)
Free Testosterone: 380 pmol/L (ref: 110-660)
Bioavailable Testosterone: 8.9 nmol/L (ref: 2.8-15.5)
SHBG: 24 nmol/L (ref: 13-89)
Prolactin: 9 ug/L (ref: 3-13)

TSH: 4.29 mU/L (ref: 0.30-5.60)
FT4: 11.5 pmol/L (ref: 7.0-17.0)
FT3: 4.6 pmol/L (ref: 3.3-6.0)

25-hydroxy Vitamin D: 105 nmol/L (ref: >=75)
C-Reactive Protein: <0.2 mg/L (ref: <=10.0)

TSH went up from 2.94 to 4.29, but FT4 and FT3 went up a little (although not much).

Anything to be concerned about with low ALT and AST? I’m assuming this just means my liver is healthy?

Also, does it seem like my Potassium is a bit low? It’s not quite midrange, and I noticed my Chloride and CO2 are at the high end of the range and wondering if this can cause symptoms? I had an ECG done recently and discovered I have an irregular heartbeat. I also find I yawn a lot (almost seems like my body lacks oxygen). Can this be connected somehow?