Educate yourself. You can either follow the recommendation of evidence based medicine or some random guy on the internet.
If you decide to take the first option make sure to read the paper i linked before and the paper linked below. Its not my personal opinion (as i am also just some random guy on the internet) but the opinion of experts in their field.
Thats another paper worth reading.
About 10–15% of patients on LT4 monotherapy express dissatisfaction due to residual symptoms of hypothyroidism.
If you feel fine on LT4 perfect, if you are among the 10 to 15% who have residual symptoms go for the combination.
Not everything requires scientific evidence to be true, one can just listen to what patients are telling their doctors.
Hypothyroidism symptoms linger despite medication use, normal blood tests
However, in recent years, patient advocacy groups have helped draw attention to the plight of hypothyroid patients who feel sick despite taking levothyroxine and having normal TSH levels.
Yes, thats the 10 to 15% of the patients.
And bias due to subjective perception is the scientists worst enemy.
Hello again guys. I’v been to my endocrinologist again in order to get a licence for MRI. He said instead there is no need in his opinion for MRI yet as prolactin levels are not high enough to warrant an MRI (he said something like results should be above 2000 at least).
So he put me on Levothyroxine medication (T4) 25mcg everyday before breakfast.
He told me to go 25mcg first week, and then 50mcg 2 days a week.
He said if we don’t get prolactin down in 1 month, he will issue an MRI test for me.
Does this sound reasonable with you?
Me again 
@johann77 @highpull @kratom_dumper
So it’s been 2 weeks I’m on T4 already (levothyroxine) but I don’t feel any better yet - My sex drive did not improve, erections are weak (although sometimes I have morning erections 5/7 days weekly I think) and still takes a lot of time for me to ejaculate while masturbating.
I’v been thinking to start bromocriptine 1.25mg as of tonight and maybe 25mg clomid every othey day. Or to start adding T3 to my T4 as well as Kratom suggested.
What do you think about all of this?
To be completely honest with you, I started talking with my ex again after a very long time and we might just try once again so I’m desperate to recover as I can’t let my erectile dysfunction kill our relationship once again.
It may take a few weeks for T4 to work. You may need to increase the dose. Some TRT/hormone doctors will titrate thyroid upward monthly until symptoms respond. As you might imagine, this can take a few months. We do not know your fT3 levels, unless I missed them. Some patients do fine with T4 only preparations, some on T3 only, and some with a T3/T4 combo. I know some who have not felt good for years taking synthroid that, when switching to a bioidentical T3/T4 combo, have done great. Like TRT, no one size fits all approach.
Given your situation with you ex-girlfriend, if I am you, “desperate to recover”, I think I would go ahead and address prolactin. Seems as though that is behind all of this. Good luck.
Typical dosage of LT in subclinical hypothyroidism is 1.2 - 1.8 ug per kg bodyweight.
So for an adult men with 85kg it would be between a 100 to 150 ug.
I would increase the dosage in 4 week intervals until you reach 100 ug, then 3 to 4 weeks later do lab work. Depending on how you feel and what your thyroid levels are then increase further in the same rythm.
I wouldn’t start with the carbon as of yet. Too many variables.
From the literature:
‚Oral levothyroxine is the treatment of choice if the decision to treat SCH has been made. Current evidence does not suggest use of either liothyronine (T3) or combined levothyroxine/liothyronine treatment for SCH [Grozinsky-Glasberg et al. 2006; Pearce et al. 2013]. The ETA guidelines recommend a weight-adjusted starting dose of 1.5 µg/kg daily (e.g. 100 or 125 µg/daily for a man, 75 or 100 µg for woman) for patients without cardiac disease and 25–50 µg daily for patients having heart problems and in the elderly [Pearce et al. 2013]. The serum TSH should be rechecked 2–3 months after starting levothyroxine with the aim of keeping TSH in the lower half of recommended range (0.4–2.5 mIU/l), though a higher reference range (1.0–5.0 mIU/l) is acceptable in elderly patients (>70 years) [Biondi and Cooper, 2008].‘
Don’t forget that the half life of LT4 is about 7 days so you are still building up the T4 levels in your system.
@johann77 @highpull
I got results for T3:
Free T3 - 3.58 (2.76-6.45)
Total T3 - 1.3 (1.3-2.6)
Guys I can’t thank you enough for your effort, it’s really appreciated!
Doctor told me to start with 25mcg daily and to increase to 50mcg twice a week before I repeat my tests in a month.
I weight ~ 105kg (230lb) so I guess I will up a dosage to 50mcg daily.
I will start with half a pill of bromocriptine (1.25mg) today.
I was reluctant to start as I was still waiting for that pituitary dedicated MRI, but I guess, if something is wrong with it (prolactinoma tumor) bromocriptine wont mask it?
Prolactinoma size rapidly decreases under bromo therapy normalizing prolactin levels (within 3 months)
Slight increase in prolactin is observed in about 25% of subjects with subcl hypothyroidism. So there is a good chance that prolactin will decrease under thyroid hormone therapy.
Maybe worth to the wait until the next blood draw at which prolactin should be included.
Just read your post again. So your current dose is 50 ug twice per week? A total weekly dose of 100ug, correct? Or 50 ug twice per week plus the 25 daily?
I think I misread your current dose to be 50 ug daily now.
50 ug twice per week is way too low. As mentioned before the recommended dose for your weight is somewhere between 120 and 180 ug daily. Even pregnant woman suffering from subcl hypoth are treated with a standard dose of 75 ug daily.
I think you need to talk to your physician.
Sorry @johann77 , I probably was not clear enough
I’m currently on 225mg weekly. I will up my dose definitely. I think it’s of no use talking to him at the moment, he put me on this therapy not willingly, it was more of “If you insist” and told me to go with mentioned dosages for a month. He thinks I’m healthy and I dont need hormones, and my results are due to stress since my thyroid, breasts etc. is fine and even prolactine is not high enough for him to presribe me pitu. screening… I really had to insist to give me a recipe for t4
You are welcome. Now we know you certainly have a thyroid problem. I think custom T3/T4 preparations are a good choice, in the right ratio for you. Sometimes, usually(?), it can take a while to determine the dose and get full benefit, regardless of what you take. Due to that and your personal situation, I still think I would address the hyperprolactinemia directly.
Ok, so I will up T4 to 50mg every day + bromocriptine 1.25mg for prolacti every evening for a month and see where do I go from there. Is it ok?
To increase your dose to 50 ug a day is definitely a good idea. But I think on the long run you need to find a way to work with your doc; you need to find out if your doc is willing to increase your dose to the recommended dose for subcl hypothyroidism.
To my experience this is walking a fine line; most probably he knows the guidelines and he just wants to make sure that you approach the effective dose slowly, decreasing the probability of overtreatment. In that case making him aware of the guidelines might just be inappropriate (guideline linked below).
On the flip side, if he really doesn’t know that you most probably need a much higher dose to find symptom relief not making him aware is a loss if time.
With the bromo it’s up to you. On the long run it might just be easier to work with one medication at a time, otherwise you won’t find out what really helps you. But I do understand your need for a quick fix. The 1.25 bromo is a low dose so I guess it’s rather unlikely that you achieve a significant reduction in prolactinoma size (if there is one) within 1 to 2 months and thereby mask anything.
I think you will need to accept anyways that figuring this out will take some time, but you are at least now actively tackling this. There are many ways leading to Rome.
All the best with your treatment and the lady, keep us posted!
thank you again for your effort, I will keep you informed. and will try to push for thqt pit. screening asap qnd then get back to you guys
Got approval from my job for pituitary screening, going after work.
Will get back to you with results
@johann77 @highpull
Just got my results for pituitary screening and results are fine. The report is written in specific language not sure I can translate it correctly as English is not my native language, but all in all - pituitary is of normal dimensions without any changes and signs of illness.
I’m starting with 1.25 bromocriptin tonight then, I have increased my levothyroxine to 50mg daily and 75mg on tuesday and friday.
Need your opinion once again on clomid after all of this - I read some reports that it can help with boosting libido and increasing testosterone, so I’m willing to try if it can have any effect?
Also, before all this shit happened to me, I’v been thinking about sarms peptides, some minimal dosages for 8 weeks.
Is it too risky to run sarms with my current condition? Not much because of my looks at the moment, but if it can increase my testosterone and general well-being, again, I’m all for it. I’v been thinking about rad 140 or lgd 4033.
It’s common to find no abnormalities with regards to the pituitary gland, over 70% never really have any concrete answers as to why testosterone is low, more than likely it’s going to be something downstream of the pituitary gland that’s causing the low testosterone.
EDC’s found in plastics, furniture, toys, carpeting, building materials, cosmetics and chemicals such as bisphenol, phthalates, flame retardants and pesticides such as chlorpyrifos block hormone production.
We are talking about very small minority have libido on clomid, most have low or no libido to speak of on clomid, once the zuclomiphene (estrogen receptor agonist) builds up in the bloodstream, you are your libido part ways.
This is very good news!
I think I can only give you the same recommendation as before, take a stepwise approach
About 60% of men with subcl hypothyroidism have ED and about 25% have elevated prolactin levels. And about 50% have low T.
So chances are quite good that by fixing the thyroid you will achieve symptom relief.
Good luck and be patient - you will get there but it might take some time!