Possible Hypothyroidism/ TRT Not Working

Pharma / TRT Testosterone Replacement
1

Hi guys,

I’m a regular on these forums, so won’t bore you with too much information! Basically, at the age of 24, I discovered I had low testosterone levels, namely, low levels of free testosterone and high oestrogen. I had suffered from a whole cluster of symptoms, ranging from development of Gyno right down to problems with erections and libido etc etc. I have been tested by two urologists and latterly an Endocrinologist, none of whom have been able to definitively identify the root cause of my low testosterone levels. Endo agreed to put me on TRT with an Aromatase Inhibitor, in an attempt to raise my T levels and bring down the high oestrogen. My current regime consists of: two sachets of Testo Gel 50mg 5g gel daily, and 2mg of Anastrazole, 1mg tablets twice a week. So far, symptoms have not improved.

I have heard, from guys on TRT for whom the treatment has not reaped significant benefits, that often thyroid function, which apparently is of central importance in an effective TRT/ hormone re balancing treatment plan, is frequently overlooked and often underestimated. I am beginning to wonder if perhaps one of the reasons why my TRT programme, which I have been on now for at least two months, is not working is because of some issue with my thyroid. My most recent thyroid labs are included below. I hope some of you guys can offer me further advice on: a- are the thyroid numbers I presently have optimal, and b-has my endo missed out something really vital in terms of the thyroid labs he has ordered? If so, what labs should I ask him to run, and what should an ideal TSH number for a man in his 20s be?

TSH: 3.73 mu/L on reference range: 0.34-5.60

FT4 level: 12.4pmol/L on reference range: 7.70- 15.10pmol/L

FT3 level: 5.8pmol/L on reference range: 4.30- 6.80pmol/L

I am led to believe that a high TSH combined with a low or borderline low FT3 or FT4 level can indicate subclinical hypothyroidism? What do you guys think, on the basis of the above labs, and the fact that my TRT programme does not seem to be working, about the possibility of my potentially having a mildly underactive thyroid? Are there any other thyroid labs I should ask my endo to do? I feel very fatigued all of the time, get unexplained muscle aches, low libido, moderate ED and problems with energy levels. I think my thyroid could be a contributing factor to some of my symptoms, but would be interested to hear thoughts of you guys.

2

Your thyoids a mess, these ranges are way to wide as there are people experiencing hypothyroid symptom on beyond 2.5 and you’re well above it. Any doctor who allows a TSH of 3.73 to not show concerned is just plain stupid and doesn’t stay ahead of the latest research. This is the type of doctor you should be looking for, one who stays informed, you need a doctor who became a doctor out of passion and not just to pay the bills.

Your rT3 is expected to be high which prevents fT3 from entering your cells. Your thyroid requires sufficient cortisol, what’s am cortisol? You can forget about feeling anything from TRT until you address your thyroid. Most progressive doctors start thyroid treatment beyond 2.5 mu/L.

Check oral body temperatures which are expected to be below 98.6, check rT3 and antibodies.

3

Do you have recent test and E2 labs? I wonder how well your gel is being absorbed.

4

Systemlord,

Thank you for your message. I thought my TSH numbers looked sub-optimal and you have confirmed it. Doctor tells me that it’s “normal”/ “in range” and therefore not worth treating alongside the TRT, despite the fact that many of my symptoms, which remain even though I am on TRT, could be due to an underactive thyroid.

What should an ideal TSH number for a guy in his 20s be, and what other thyroid labs should I request my doctor to do? Seems like you have expertise in the concurrent management of thyroid issues on TRT, so I welcome your input.

5

Insurance companies love these ranges, it save billions on healthcare. The doctors who take insurance are in bed with big pharma and the insurance companies and decisions about the quality of your healthcare are being made behind your back in relation to when a doctor start showing concern.

These ranges are bogus, the sick care model is setup to start treatment when things are about as bad as there going to get. If every doctor began thyroid treatment just past 2.5 insurance rates would skyrocket as all of a sudden tons of people would begin thyroid treatment and insurance companies worst nightmare would be realized, profits would suffer.

Fight for your health.

6

What is classic is that skin changes with hypothyroidism make transdermal T absorption poor or nil. Then T injections are the only option. As you are young and need to inject 250iu hCG SC EOD to preserver fertility, injecting T is a no-brainer.

Eval overall thyroid function via oral body temperatures - see below.

Discuss history of using iodized salt. Iodine deficiency might be root cause.

TSH should be near 1.0
fT4 should be near mid-range is appears OK
fT3 is the only active thyroid hormone and should be mid-range or a bit higher. Your FT=5.8 suggests that fT3 is not working and we then suspect elevated rT3, reverse T3 is blocking at F3 receptors.

tT3 can be elevated from:
a stressful live
major stress events
illnesses
injuries
starvation diets
training with low T and low thyroid function

Thyroid is way more complicated than T issues and most docs are very clueless. But you can read what is here and in the thyroid sticky and be able to guide your own destiny.

Thyroid lab ranges are very useless. But according to them you are normal. So asking your endo is a waste if time+$

This state could promote thyroid autoimmune disease if you are selenium deficient. Find a multi-vit with 150mcg iodine and 200mcg selenium. This is not an idle nice to have suggestion.

As for low-T…
We really need the labs in list format with ranges and do not skip anything, normal or not. You are not going to get much help here without lab data.

Gyno can also be from prolactin+estrogens.
Was prolactin tested?

Because most symptoms of low thyroid function are the same as low-T, you are not feeling what TRT was expected to deliver.

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.

7

You seem like the most knowledgeable person in any forum. Can you advise on non-surgical gyno reversal? I just turned 38 and I’ve had it since I was 21-22. it doesn’t look too bad, but I still have puffy nipple and areola. I started TRT 2 years ago and I’m currently taking Prop 150mg/wk (75mg twice a week) with 0.5mg of Arimidex 3 times a week. I took tamoxifen and Clomid on PCT for 3 weeks before I got back on the T cycle. My estradiol was normal from my recent physical and last year’s, but my free T was slightly lower than the average and I’ve also noticed that my climax doesn’t feel as good since I had started PCT.

8

The long gyno has persisted the more mature the tissue changes are and thus are more persistent.

WTF: “My estradiol was normal”
Normal range includes level that are way too high.

You need E2=22pg/ml, perhaps a little lower.
Anastrozole is a competitive drug that needs to match serum T levels. If you change your T dose, your anastrozole dose also need to change.

You are not addressing all of the points and suggestions that I made. You need to get busy if you want to be healthy. Do the reading and address the thyroid issues ASAP.

9

Thank you for sharing. I have so many questions, I wish you were my doctor. It looks like I’ll be on T for many years and I want to do it right. My E2 was actually 20pg/ml, so I think I’m good. My gp went over the results from my recent physical and said my overall health including thyroid, liver, prostate, bp is excellent. my cholesterol was a little too high at 120, but I have clean arteries. Do you think I should see a urologist for another blood work on hormones? what other things should I include in the blood work? sorry to be a pest and thank you again for your time.

10

A TSH of 3.73 isn’t considered excellent, most thyroid doctors are lacking in knowledge and fail proper testing and undermedicate patients. Most also blindly follow these stupid ranges which are too broad, you need to do your own research and learn for yourself.

I suspect Reverse T3 to be a problem which most doctors don’t test for, what a shame.

11

Doctors get fooled by thyroid lab ranges that are very useless and they also do not understand the fundamentals. Your oral body temperatures will tell us a lot about your thyroid function, that is something you need to get done.

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.