T Nation

2 Doctors. 2 Opinions. Hashimotos? HRT?


#1

age 39
height 6’2
36 waist pants size
Body hair has been light all my life. Back hair has increased in past 4 or so years. Facial hair will only grow to about an half an inch long and stop on the jaws, maybe a little longer in the goatee area. Top of head seems to have recently stopped growing hair or just really slow.

Store all my fat in the chest and gut area. Its been this way all my life. Trim everywhere else. Trim legs and arms. Noassatol.

When I was 18 yrs old I was diagnosed with Mononucleosis and Yellow Jaundice. Spent two months in the bed.

I have struggled with anxiety and depression to the point of social withdrawal. Tried paxil and wellbutrin around the age of 25. Decided i would rather do without them. I probably didn’t take a whole bottle of either one.

January 2015. Seems like I lost my libido and the ability to get an erection almost over night. I was laying in bed and the thought occurred to me that I have not been horny in a week or two. I had been experiencing moodiness and fatigue for years, maybe even a decade at this point. Found a Primary Care Physician to discuss these symptoms and more. Found out I had H. Pylori with a stomach ulcer. The doctor was not really concerned about my ED and libido loss and chalked it up to getting old. I was not satisfied with this so I got my T checked. It was low. Started T therapy {pellets} in Oct. 2015 with a urologist (no hCG, no AI) and got good results in the erections department, but my libido did not recover. The good results disappeared three months later in January 2016, went back to struggling in the sack. Late March 2016 tried more pellet with no success in the bedroom. With help from this website I think I know why it has failed me. I am done with pellets. Found a functional medicine doctor I think I am gonna go with. He mentioned that we could try getting me off of HRT and try a restart. I didn’t think this was possible after starting therapy.

It was a battle but I talked my PCP into checking my thyroid a little closer.
This is what I got back
fT4 = 0.73 (0.65 -1.25 ng/dl)
fT3 = 4.13 (2.50 - 3.90 pg/ml)
Cortisol PM = 21.2 (3.1 - 16.7 ug/dl)

Which prompted these tests
Thyrogl autoab = <0.9 (0.0 - 4.0 IU/mL)
Thyroidperoxab = 20.4 (0.0 -9.0 IU/mL)
and a Dexamethasone Suppression Test which yielded
Cortisol AM = 0.8 (4.3 -22.4 UG/DL)

I was then sent for a Nuclear Thyroid Scan. Administered 296 uCI of I-123 sodium iodide.
4 hour uptake was 7% with a 24 hour at 17%.
Planar Imaging demonstrated homogeneous uptake within the thyroid gland. No evidence of hyperfunctioning or hypofunctioning nodule.

Alright here’s the thing. After all this the PCP says everything is normal. The functional medicine doctor says I have Hashimotos auto immune disorder. He pointed to the elevated FT3 and high thyroidperoxab and said “I know you have an autoimmune disorder.” Any thoughts and advice are greatly appreciated cause I can’t afford many more professional opinions. I was very close to trying Iodine replacement. I haven’t salted food for 20 years. I would like to rule out Hashimotos first right? My body temps run low. 95- 96 are the norm in the morning. Low 97s throughout the day.

One thing I found interesting from the functional med doc is that he is concerned about mono showing back up in my testicles causing this whole mess and wants to do lab work. First thing we are gonna do is the 4 sample saliva test as we are very concerned about my cortisol numbers. I just wonder if my cortisol numbers are skewed because HRT without hCG.

Previous TSH Labs
03/11/2015 - Prior to HRT taken at PCP
2.51 (0.34 -5.60 uIU/mL)

08/29/15 - Prior to HRT taken at testosterone center
3.040 (0.450 - 4.500 uIU/mL)

04/29/16 - Post HRT taken at PCP
2.02 (0.34 - 5.60 uIU/mL)


KSman is Here
#2

Man I was hoping someone could relate with those numbers. I have got this saliva sample test here, and I am just thinking I might want to wait until the pellets wear off to maybe be a more accurate test.


#3

Seen the doctor today and had to educate her on E2 compared to Total Estrogen test. I should have some E2 results in about a week. Currently has me injecting 100mg T cyp with 0.5mg of anastrozole compounded twice weekly getting my Total Estrogen to 249.5pg/ml out of the 60-190pg/ml range. My question is, would I be correct in assuming that my E2 is high since my Total E is high. I have some leftover 1mg anastrozole pills from a previous script so I am wondering if I could take one or two to make me feel better. No libido. Weak erections that I can’t maintain. Just concerned about high levels of E.


#4

We typically test E2 because we are controlling FT–>E2 with anastrozole. Whole story… no. But we do not have any sense of what a total E target should be.

Years of high TSH from not using iodized salt and a presumed selenium deficiency has caused free radical damage to thyroid cells and the immune system has to routinely clean that cellular wreckage up and misinterpreting that mess as foreign. You may be able beat this. Get some 200mg selenium supplements and take for 3 weeks, then introduce more iodine. If you do not get the selenium on-board first, things could get worse.

Please read the stickies found here: About the T Replacement Category

  • 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.


#5

Thyroid was an issue to begin with. My numbers in line with the help of diet, selenium and iodine I believe. Even one of the Hashimoto numbers is back in range. My main concern was in my last post, is it safe to assume my E2 is high, given my Total E is high and could tolerate an extra dose of anastrozole without getting it too low? Just in search of some relief.


#6

I have no idea what levels of total E2 are somewhat optimal. That is the issue. Can you get E2 tested?

I reacted to this out-of-range: Thyroidperoxab = 20.4 (0.0 -9.0 IU/mL)


#7

Bare with me I am confused. Not hard to do with all this fog in my head. I did convince the doc to test my E2 yesterday. I should have results in a week. The number I do have is what she called a “Total Estrogen” number. She uses Quest labs and the range is 60pg/ml-190pg/ml. I am at 249.5pg/ml. Her response was that this was not that bad. I told her that high Estrogen is not healthy in men and after further discussion I figure out that this was not the number we need to look at. That we needed to be looking at estradiol aka E2. Not “Total Estrogen”.

What I am wondering is if it safe to assume that my E2 is high allowing me to take an anastrozole to knock it down for some temporary relief while I am waiting those E2 results. From what I understand it is not good to get it to low either. I have searched to find what all estrogens (e.g…E1, E2, E3) are included in this “Total Estrogen” test to see if there was some math I could do to find the E2 value of the “Total”.

I posted this question in the estradiol sticky but while I got you here I will ask again. She says a person can take 75% less of an AI when on a compound script that it bypasses the liver. I have read this anywhere. My script is 100mg T cyp w/ 0.5mg anastrozole X2 weekly.


#8

You were using any anastrozole for those labs that you posted?
For the E2 test just done?

There can be some abnormal estrogen metabolism going on and liver problems and interference by some medications Rx or OTC. Estrogen levels are a balance of production and liver clearance. Some estrogen metabolites can be converted back to estrogens by adverse gut bacteria and reabsorbed. Some labs to evaluate liver function are useful with AST/ALT at a minimum. Liver problems are mostly uncommon in guys who come here.


#9

Yes on the Estrogen labs. On .5mg of anastrozole along with 100mg of T cyp injected every 3.5 days. Never took an AI while on pellets i spoke about in that post from a year ago.

Numbers that I know relate the liver:
From 6-12-2017
•In Range
Range. Result
Albumin 3.6-5.1(g/dL)= 5.0
Globulin 1.9-3.7(g/dL(calc))=2.5
Albumin / Globulin Ratio 1.0-2.5(calc)=2.0
AST 10-40(u/L)=22
ALT 9-46(u/L)=29

•Out of range
Bilirubin 0.2-1.2(mg/dL)=1.5
I think this may be a result from the mono (EBV)I had in high school I spoke about in the post from a year ago. Not aware of anything that can be done about it.

Other Labs of interest

Out of range
Total Testosterone 250-827(ng/dL)=1260
MCHC 32.0-36(g/dL)=31.2
Hematocrit 38.5-50(%)=51.8
Iron binding capacity 250-425(mcg/dL(calc))=428
Ferritin 20-380(ng/mL)=12

In Range
Total Iron 50-180(mcg/dL)=66
Hemoglobin 13.2-17.1(g/dL)=16.1


#10

Got the labs back.

In range:
Estradiol < or = 39(pg/ml) = 25
Ferritin 20-380(ng/ml) 35
AST 10-40 (u/L) 17
ALT 9-46(u/L) 27
Urea nitrogen 7-25(mg/dL) 25
Creatine 0.60-1.35(mg/dL) 1.08
Albumin 3.6-5.1(g/dL) 4.8
Globulin 1.9-3.7(g/dL) 2.3
Albumin/Globulin ratio 1.0-2.5(calc) 2.1
Alkaline Phosphate 40-115(u/L) 89
White Blood cell count 3.8-10.8 (thousand/uL) 4.6
MCV 80-100(fl) 86.7
MCH 27-33 (pg) 28.8
MCHC 32-36(g/dL) 33.2
RDW 11-15(%) 15
Platelet Count 140-400(thousand/uL) 185
MPV 7.5-12.5 (fl) 12.3
Absolute Neutrophils 1500-7800 (cells/uL) 2912
Absolute lymphocytes 850-3900 (cells/uL)1288
Absolute monocytes 200-950 (cells/uL)331
Absolute eosinophils 15-500 (cells/uL) 51
Absolute basophils 0-200 (cells/uL) 18
Neutrophils % 63.3
Lymphocytes % 28
Monocytes % 7.2
Eosinophils % 1.1
Basophils % 0.4

Out of Range:
Bilirubin 0.2-1.2(mg/dL) 1.9
Red Blood Count 4.20-5.80(million/uL) 6.08
Hemoglobin 13.2-17.1(g/dL) 17.5
Hematocrit 38.5-50(%) 52.7

E2 is close but I have read a few cases where people get symptomatic at 25pg/mL. Gonna push for the EOD strategy. Gotta get out of this funk. Can’t lift, can’t run, can’t …


#11

Been on the 250iu EOD method for over a year now. The boys are definitely shrinking up. Is it possible some people need more. Is it possible I have desensitized the Leydigs? Have had the 4 sample saliva test indicating low DHEA and serum pregnenelone checked with deficient results there also.

I take a 50 or a 100 slin pin and draw it to 25. Is this correct dose. It’s a 10000iu vial. My doctor says it is but I wonder about her sometimes.


#12

Do you put 10ml of water in the vial when you mix it? How long does that 10,000iu vial last you?


#13

I am sorry. I don’t know what I was thinking yesterday. I don’t mix it the pharmacy does. It is a 10ml vial with 1000u of hCG per mL.