TRT & Thyroid Optimization - Different Doctors?

Pharma TRT
21

This is where it gets complicated:

3 months on 2 grains Armour t4/t3 compound + 30mcg Cytomel (Total 76mcg T4 and 48mcg T3) - I thought this was less originally, but I looked back at my log to confirm this was the dosing I ended in August.
Three months of this got me:
Thyroid numbers up (3.9 Free T3, but 15.6 Rev T3). BUT
SHBG went from 74 to 117

Dropping t4/t3 combo and sticking to 45mcg Cytomel for 3 months:
Free t3 from 3.9 to 2.4, Rev t3 from 15.6 to 6.7
SHBG went from 117 to 91

So now Iā€™m on TRT+HCG, but you guys are suggesting that the with the high SHBG, it will take longer to get my Test/E2 levels right. But also suggesting that I need to increase my thyroid medication.

By upping my thyroid medication, would I be upping my SHBG as well? Are do you feel these were unrelated?

What I will also share is:

3 months of JUST 2 grains Armour (no cytomel), I felt no relief of symptoms. Throw in 30mcg of Cytomel in addition, and things got working. - Is this just a matter of this taking time to work, or was the addition of T3 just what was needed?

Prior to any treatment, my SHBG was 58.6 (already high). I was put on Clomid for 3months. 6 weeks 12.5mg EOD, then increased 6 weeks to 25mg daily. This got me to 74 SHBG in MAY, then i STOPPED clomid, and continued Thyroid meds, then my SHBG was 117 in AUGUST. - Again, was this the aftermath of Clomid, even though I had stopped clomid for 3 months, or was this due more to thyroid meds?

Given all of the above, what is the suggested Thyroid dosage I should go up to?

And for the Test/E2, I presume continuing 200mg .40mg Test/.400 IU HCG 2x per week and allowing Defy to see where my levels are at 3 months from now is all I need to worry about.

22

Yes, and no.

Itā€™s possible youā€™ll need to go through a series of increased doses.

Now itā€™s speculating, but given your fT3 levels, it seems so. This is why I like T3/T4 custom dosing.

Thyroid mostly.

Seems like the original rx was working.

23

You were trying to optimize your testosterone parameters (by lowering SHBG) by creating a suboptimal thyroid protocol which would see all your levels drop to hypothyroid tertiary. Your thyroid levels were perfect, but your testosterone parameters were shit.

Nobody said itā€™s going to take longer, it will take more androgens to suppress SHBG.

This is the answer, your mistake was dropping the T4/T3 combo and sticking with T3 only which would see fT3 and rT3 plummet and this is why SHBG decrease.

Iā€™m going to assume you started TRT with fT3 low.

24

In February 2018 *before any treatment, thyroid was:
Ft3 2.4
FT4 1.23
Rev T3 13.8
TSH 2.090

So it was ina worst state then, but that was when I was put on just clomid. No thyroid meds. This is one reason why I questioned if Defy Medical was the best place to treat thyroid.

If it is believed that the higher thyroid dosage is causing my already high SHBG to go up so much, why would I want to increase thyroid dosage? Seems like I would be upping thyroid, in turn upping SHBG, which then would force me to up Test Cyp injections (how much would be determined by Defy after labs 3 months from now). Seems like I would be fixing one issue with the thyroid, while creating another, with the Test/e2?

Perhaps I didnā€™t state it in this thread, but I did not take my T3 medication the morning the labs were drawn. The previous day, I took 35mcg T3 at 6am, and 10mcg at 3pm. I had the blood labs taken at 8:30am, the next day. However, Defy did not give instruction to take it before labs, or ask if I had taken it or not. But I was told here that this alone could throw the FT3 numbers off quite a bit.

25

Just to be clear, you were low testosterone, so they gave you Clomid. Then, later, it was determined you needed thyroid. While a lot of low thyroid symptoms are the same as low testosterone, some need both. You were feeling pretty good with the thyroid rx, but SHBG increased, which is to be expected. So, thyroid was reduced, with the expectation it would be discontinued, and testosterone and hCG were added. Now, youā€™re not feeling as well as you were.

Is this accurate?

Most doctors will not only want you taking your usual dose, but with thyroid, will specify when you should get your blood drawn, depends on any symptoms and the thyroid preparation being used.

26

Cytomel half life is over by lunch time. No way. Doctors not very in the know if they donā€™t even know the basics f the meds they dispense to you.

Thyroid 101 know your half life

1 Like
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The timeline:

  • Looked for treatment due to symptoms weight gain, low libido, and irritability.
  • Low test, low estrogen, low thyroid was shown from labs. Clomid was introduced. No improvement felt in symptoms, but my sleep was amazing. From the Clomid?? (~3 months)
  • 2 grains armour thyroid introduced. no improvement felt. (~3 months)
  • 2 grains Armour t4/t3 compound + 30mcg Cytomel (Total 76mcg T4 and 48mcg T3) Lost 20 lbs (back to ~10% BF)
  • T4/T3 compound dropped, 45mcg T3. Weight was maintained for the most part, but a slight creep up.
  • T3 medication reduced to 20mcg.

My primary concern is letting the thyroid slip and end up fattened up again. Iā€™ve always maintained exercising 5-6x per week, and watching my calories. This has always kept me pretty lean, until 2018. For 18 months, no matter what I did, the weight just went up and up. It was a long road to finally get my body working right. Iā€™d hate to let it fall,and have to reboot it again. This may seem like a small thing for many, and pale in some other symptoms. However, Iā€™m not a a big dude, and work in fitness, so 20 excess lbs was a big deal for me. So Iā€™m alarmed by the bad thyroid numbers from the labs.

As far as how Iā€™m feeling - There have been days where I have no energy and am super irritable. But maybe that was the low T/E2? I have good and bad days in these areas, which is quite noticeable. Itā€™s the weight that is such a gradual change that makes it hard symptom to monitor.

Maybe another rabbit hole Iā€™m creating here but another thyroid forum suggested me working out 6x per week was the problem, and my cortisol might be way too high. A blood cortisol test was normal, but it was suggested that a saliva cortisol test would be better.

28

I donā€™t know if you can make suggestions to your provider or not, but they need them. Given what youā€™ve reported, it does not seem that difficult.

Thyroid, you know what works. T3/T4, get back to that.

Testosterone, I would start with 200mg a week. See where that puts your free testosterone and E2. Titrate upward if necessary. I would think a competent doctor could make the appropriate adjustment quickly, if needed.

29

T3 taken before breakfast at 8 am will result in peak or close to peak levels at lunch time.

,With respect to T3 administration in euthyroid patients, T3 kinetics are similar regardless of whether T3 was provided in the form of a synthetic preparation or a thyroid extract (4). Seventy-five mcg of synthetic T3 resulted in a peak concentration of T3 of 550 ng/dL 4 hours after dosage administration. The area under the curve (AUC) corrected for the T3 content of the administered tablet did not differ between the 3 preparations and was in the range of 3,500ā€“4,500 ng.hr/dL over a 26 hour period (4). Another study employing an oral dose of 75 mcg of T3 also showed a time to achieve maximum concentration (Tmax) of between 2ā€“3 hours (5)

Studies reported by Nicoloff and colleagues in 1972 calculated a half-life of T3 that varied with thyroid status (8). The mean half-life was 0.63 days in 7 hyperthyroid patients, 1.0 day in 8 euthyroid individuals, and 1.38 days in 9 hypothyroid patients.ā€˜

30

Yes maximum concentration is low after a few hours and thatā€™s why the specialists in thyroid medication give 2 dose of armour thyroid daily or 3 of t3 only daily. You have to keep t3 top of range to feel the benefits. If it goes below you feel fatigued and tired.

Have you ever taken thyroid medication?

I guess half life is being used incorrectly here in my comment.

31

A lot of patients have reported that it works best for them to dose the T3 three times a day because of its short half-life, such as first thing in the morning, about 4 hours later, and another 4 hours after that. Some might add a small amount like 2.5 mcgat bedtime, but thatā€™s individualā€“it helps some sleep better; others it keeps awake.

We have noted that it doesnā€™t matter when the T4 is taken (as simply a storage hormone that will be converting all the time) as it does with T3 (as the active hormone). For convenience sake, the T4 can still be taken once a day in the morning, or at bedtime.

When on the T4/T3 combination, patients have noted that optimal equals a free T3 towards the top part of the range, and a free T4 right around mid-range. Why only around mid-range for free T4 or very slightly above? Because over time, patients started to see an increase in RT3, the inactive hormone, if they went too far above mid-range.

Bottle of T3

If patients are on T3-only by itself, how does it work? What is optimal?

Generally, if one is not used to being on T3, reported starting doses are 5 mcg in the morning, and another 5 mcg when oneā€™s signs (BP, heartrate, etc) and symptoms (tiredness) dictate it, etcā€“thatā€™s usually about 4 hours after the first dose. A third dose is added about four hours later. Remember that we have to have the right amount of cortisol to avoid problems when on T3 or when raising it.

Raising in small amounts seems to work, too, and using labs. This is NOT set in stone, but seems to work best for people as they have stated, especially if they are not used to having T3 in their treatment.

Some patients have stopped NDT or the synthetic T4/T3 combo one day, and started on T3-only the next. But it has to be in very small amounts until the T4, and its conversion to T3, falls, before raising too much.

When optimal on nothing more than T3-only, patients report they achieve a free T3 at the very top if not slightly over . Free T4 will naturally be quite low and patients have not found that to be a problem as long as they are multi-dosing.

32

Iā€™ve requested from Defy that Iā€™m able to order the t4/t3 compound that I was on previously, when things were looking good. If nothing else, it would be good to have some on hand, if these symptoms do not get better. Iā€™ve definitely had far less energy, and been much more irritable as of late. Iā€™m also going to take a week to rest. Given that I typically train 6x per week, and have done this for some time,Iā€™m going to see if this helps with energy, mood, and sleep. Hopefully ordering the t4/t3 compound will be approved, so i can at least have some on hand, and I can implement that again if symptoms to not improve.

When I was doing t3 only I was doing 35mcg at 6am, 10mcg at 2:30pm.

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3 highly interesting publications absolutely worth reading:

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34

I talked with a defy nurse the other day, and they approved re-ordering a supply for 2grain armour t4/t3 compound. Previously I took 2 grains armour + 30mcg T3, and had success with that (free T3 got to 3.9). Currently I only have 35mcg T3 pills, and 10mcg pills. Iā€™m guessing 2 grains armound + 35mcg T3 wonā€™t be too much (just 5mcg more)?

Any input on the smartest dosing timing for this? I was thinking taking 2grains t4/t3 compound first thing in the morning (~6am), then the 35mcg before lunch (~11:30am)? or a couple hours AFTER lunch (~2pm)? Any recommendations?