Start TRT and/or Taper Off Thyroid?

Pharma / TRT Testosterone Replacement
1

Back in 2018 I began seeing the doctor because of symptoms of unexplained rapid weight gain, low libido, irritability, and insomnia. Since starting a program that has involved thyroid medication, over the counter supplements, but NOT TRT, the weight has gotten under control. Libido, irritability, and insomnia maybe slightly better, but still there.

Current labs
Total Test - 623.6 (264-916 ng/dL)
Free Test - 7.5 (8.7-25.1pg/mL)
Estadiol sensitive 7.9(8.0 - 35.0)
SHBG 91.1 (16.5 - 55.9)**
Free T3 - 2.4 (2.2-4.4)
Reverse T3 6.7 (9.2 - 24.1)
IGF-1 142 (88-246 ng/mL)

Labs from 8/6/19
Total Test - 754 (264-916 ng/dL)
Free Test - 7.5 (8.7-25.1pg/mL)
Estadiol sensitive 10.7 (8.0 - 35.0)
SHBG 117.5 (16.5 - 55.9)**
Reverse T3 15.6 (9.2 - 24.1)
IGF-1 142 (88-246 ng/mL)
LH - 3.8 (1.7-8.6)
Free T3 - 3.9 (2.2-4.4)
TSH .006 (.450 - 4.500)
Free T4 - 1.05 (0.82 - 1.77)
DHEA 410.8 (138.5-475.2 ug/dL)

So my SHBG was super high from 8/6, leading to low Testosterone and low Estrogen The doctor suggested Boron and ZMA instead of TRT since I was still in the family planning stages. My wife and I may want another kid a year down the road, but that remains undetermined. Therefore, I’ve been hesitant to pursue TRT.

For the testosterone/estrogen, the doctor offers two options:

  • Begin Sermorelin, cut T3 medication to 20mcg daily or eliminate T3 entirely(instead of 45mcg)
  • Begin Testosterone & HCG ongoing. Remain on both whether I decide to have children or not.

I’m assuming the latter option is going to be the consensus here. My concerns would be fertility , and potentially any other side effects?

For my Thyroid - Back in 2018 I gained a lot of weight. A 15% increase of weight in a year, and it continuing to go up. It wasn’t until I was on Cytomel (pure T3) for a decent amount of time that I was able to get control of this. The labs from 8/6/19 were a huge improvement to my thyroid numbers. It appears that my current labs are an even bigger improvement? (Better Free T3 to Rev T3 ratio)?? The doctor said I might be able to stop taking the cytomel, as that may be contributing to my insomnia, and raising the SHBG. I am wary of cutting the cytomel, as the rapid weight gain was by far the worst of all the symptoms I was experiencing. Doctor said often cytomel is something that can be cycled off, where as just the TRT is something that needs to be ongoing? The doctor also suggested to stop the afternoon dose of cytomel, as the doctor believes this could be the reason I am not sleeping well.

I’m still hesitant to begin TRT. Family planning being one concern, commiting to being on it for the rest of my life at a young age, and quite honestly cost forever is a bit of a concern too. I’ve read some people here being in misery before they began TRT. I’d say I could be better, but am in no way in misery. What improvements might I notice if I began TRT? Better sleep, energy, and moods - what extent? I will also mention I train pretty hard 6x per week w/ a very calculated diet, but look like just a generally fit guy. I wonder how much of the low testosterone is to blame for this?

So my questions:
What benefits would I notice by starting TRT, and how concerned shoudl I be with it affecting my fertility?

Should I continue to take 45mcg of Cytomel? Or Taper it? Or completely eliminate it?

I appreciate any valuable input/experiences.

2

Why would you ever want to quit the T3 when you have hypothyroidism?

It makes zero sense.

2 Likes
3

You’re not going to lower that astronomically high SHBG without TRT. There are lots of men having babies on TRT, you just have to know how to play the fertility game. You can always restart the HPTA with clomid or add HCG and FSH injections to your TRT protocol.

It will be hard to keep the weight off with low testosterone even with optimal thyroid levels. This is as best as things are going to get until you go on TRT. You will go right back to how your felt before you treated your thyroid if you stop thyroid treatment.

Your quality of life will improve across the board, your case is severe because your FT levels are goddamn low. Apart of you wants to start TRT right now or you wouldn’t be here now. I don’t understand your anxiety with fertility, there are many ways to deal with it.

4

This.

5

You do know that hypothyroidism decreases the odds of getting the woman pregnant?

Also, if I understand it correctly, you recent lab value is the one on the top right?

If so, your FT3 is absolute shit and I can’t understand why this happened considering you had great FT3 values on the 8/6.

Your doctor seems like an absolute idiot or I am missing something.

6

Lot of things stand out here. 1) SHBG is unbelieably high, 2) Free T is very low, 3) E2 is very low, and 4) FT3 is very low.

I’d go back to the Cytomel/fix your thyroid, then begin TRT as your levels are far from normal.

8

What could possible made his SHBG value this insanely high and how do you fix it?

9

The thyroid meds are raising it a bit. But his baseline must have been high to begin with.

10

Interesting, how big difference does T3 usually have on your SHBG if you are on a correct dosage?

11

I mean. Mine was higher than that pre TRT so I’m not impressed (150’s)

1 Like
12

You talking to me?

13

I don’t think there is a discrete value, I think some people are more sensitive than others. My thyroid has been much lower and much higher than his and my SHBG has been at the bottom and top of the normal range, but never over or under. It’s also a little weird his TSH is pretty much zero.

14

Sounded a little bit like bro science from the doc considering hypothyroidism is bad for fertility.

And actually, you want to have a TSH value of 0.01 while you are on T3.

15

Where did you hear that from? It doesn’t matter where your TSH is as long as your other values are optimal and symptoms are being treated.

I’m only saying it’s weird, because you would typically see TSH higher than that for the corresponding FT3 and FT4.

16

T3 is suppressive to the upstream values

17

In regards to my thyroid, I thought the improved Free T3 to Reverse T3 meant my thyroid was looking better??

On 8/6
Free T3 - 3.9 (2.2-4.4)
Reverse T3 15.6 (9.2 - 24.1)
390/15.6 = 25

Recent labs
Free T3 - 2.4 (2.2-4.4)
Reverse T3 6.7 (9.2 - 24.1)
240/6.7 = 35

I was told that anything below 20 is in need for treatment. I thought anything above 20 was good, and higher the better, assuming there are no signs of hyperthyroidism. Am I mistaken on this? Free T3 being the accelerator and reverse t3 being the brakes to slow things down, it how it was put to me. Can someone speak more on this?

If my Thyroid numbers now are actually looking worse, I may want to go back to the protocol I was on before, which was 2 grains armour thyroid (t3/t3 blend) and 35mcg Cytomel. But again, these latest thyroid numbers weren’t a red flag to me, or the doctor. If someone could speak more to this, it would be appreciated.

18

Looking over 100 different lab works has shown me that most people have their TSH values almost at zero when they actuallly are optimal on T3.

19

I really don’t understand why the ratio of your FT3 and RT3 is so important?

Your doctors seriously sounds like an incompetent idiot that have no idea what he is talking about.

Your thyroid value right now is really crappy and you need to increase your T3 dose.right away.

If you worried about getting too high RT3 again, then just don’t start taking NDT, and instead just add more of your Cytomel. The most important thing for you right now is to get your FT3 values at the very top of the range.

20

Prior to the 8/6 labs, I was on 2 grains armour thyroid 76mcg t4 /18mcg mcg T3) + 30mcg Cytomel (30mcg T3). This made a total of 48mcg T3. You can see that this protocol brought me to Free T3 of 3.9 but Rev T3 of 15.6.

Since these labs, I dropped the armour thyroid and just took 45mcg of Cytomel. I’m not sure why my Free T3 dropped as much as it did, but given the Reverse T3 dropping so much, I thought the Free T3/Rev t3 ratio was looking good to where it wasn’t a concern. I’m no expert, which is why I’m looking for other insights here.

@systemlord & @highpull - I appreciate the insights you’ve provided in the past. I’d like to hear your take on this thread?

Thank you

21

@Stealthforce - It seems your body was converting some of that T4 provided by the Armour to T3 and RT3. By dropping the Armour, you’ve lost that T4 for your body to try to convert to T3 (or RT3 if other things are happening in your body).

I’m sorry if you’ve answered, but why did you drop the Armour again? Was it to reduce RT3? Is 15.6 really that high? Curious because mine is 15 and my doc didn’t think it was a problem.

How did you feel when you had the 8/6 blood work done, with higher FT3 and moderate RT3?

Do you feel better now or then?