T Nation

2 Months TRT Bloodwork. Thyroid in Shambles

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05 PM

Started TRT two months ago. Feel much better overall.

-100 mgs test cyp injected twice weekly (200 mgs total)
-500 IUs HCG injected twice weekly (1000 IUs total)
-0.25 mg arimidex once weekly

Just got my first bloodwork set back. I’m very concerned about the thyroid values. I was hypothyroid prior to starting TRT but had it under control with NatureThroid. TRT seems to have completely thrown my thyroid off track though.

-My TSH was around 2.0 before beginning TRT. It is now in the 6 range.
-My thyroid peroxidase is 15. I did some research online and found that elevated peroxidase can signal graves or hashimotos. Is this true?
-My Free T3 has always been in the lower end of the range. It shot up out of the higher end of the range on this blood test which I guess is good…but I’m confused because my Reverse T3 also is elevated. I thought that when FT3 rises that RT3 usually falls.
-My estradiol is very low. Could this be impacting the thyroid values negatively?

I feel good overall since starting the shots. However, my outer eyebrows have been rapidly thinning since starting the Testosterone shots, another common indicator of thyroid problems.

Clearly, this is all somehow negatively affecting my thyroid. I’m open to any suggestions.

PS: I’m also a little surprised that my testosterone values aren’t higher considering I’m on such a high dose of testosterone (200 mg weekly) and HCG (1000 IUs weekly). Most guys I see with dosages that high have much higher testosterone levels. I was expecting/hoping I’d be able to lower my dose because I’d be way out of range. Looks like I’m pretty close to the top end of the range though. Could this mean my testicles aren’t responding to the HCG?


Ok, so I discovered exogenous testosterone DECREASES thyroid binding globulin (TBG) which in turn boosts FT3.

Estradiol INCREASES thyroid binding globulin, and my estradiol is extremely low on this bloodwork.

Not sure if I’m allowed to link the medical studies showing this, but if someone gives me the green light I’ll post them.

Anyways, the high FT3 values are easily explainable based on this knowledge. I have an imbalance of testosterone and estradiol in my body that is affecting my thyroid negatively. I have to much testosterone which is lowering TBG and to little estradiol.

What I still don’t understand is my high RT3 level and my elevated TSH. The only theory I’ve come across is that when there is an excess of FT3, the body will raise RT3 to block receptors from the excess FT3. As far as the elevated TSH…I have no idea.

Hoping KSman or some of the other thyroid gurus on this board will chime in here.

Nobody? Ksman?

My eyebrows are rapidly falling out. My doc wants to switch me to synthroid and away from armour which I’m currently on. I’m concerned though since synthroid has no T3 in it.

E2 too low
reduce arimidex by factor of E2=7.6 /E2=22pg/ml target
how are you managing 1/4mg now?
dissolved in vodka 1mg/ml?

Good thyroid function is often achieved with midrange fT3. You have high fT3 and when rT3 is OK, high TSH is unexpected and unexplained.

TPO does not indicate a thyroid auto immune issue.
200mcg selenium is protective.

What is your iodine intake history, iodized salt, vitamins?

T4 only meds increase T4–>rT3
higher dose T3 depresses TSH then less T4 then less T4–>rT3

We might have a better understanding if you provide oral body temperatures [see below] and also discuss your thyroid symptoms hypo VS hyper.

Thyroid labs are affected by when you take thyroid meds. How often dosed? Thyroid labs may be a dosing artifact. You are hyper and under medicated, take a dose of NT then labs soon after that show your dose but not your status. Need body temperatures.

TRT labs are sort of mostly useless when injecting once a week as the results are mostly determined by lab timing.

fT3 is the active thyroid hormone. If elevated, TSH should be lower. See above post for other explanation.

This is true in most cases, but an elevated RT3 blocks off the receptor sites which prevents the FT3 from being utilized thus creating a hypothyroid environment. It’s called “pooling”. I have plenty of FT3, but it’s not doing me any good because the RT3 is blocking it.

I’ve honestly just quit taking the anastrozole. Every time I’ve had my blood tested, my E2 has either been low or borderline low. Before this most recent blood test, my arimidex dosage was at .25 mg total per week. I’m going to have to go to a compounding pharmacy and get them to mix it with vodka. My next dosage will be .125 mg dissolved in vodka solution once a week. I’m not sure if I just don’t aromatize much or if I’m an arimidex over-responder. Seems to be a bit of both.

Yes, high FT3 would usually indicated good thyroid function, but the RT3 is blocking the FT3 from being utilized by the body.

I’m currently on 200 mcg selenium/day. Any benefit in raising it to 400?

My iodine intake was sparse growing up. Currently I’m on 12.5 mg/day combined with selenium as recommended by two doctors.

My body temperature rarely goes above 97 degrees. Upon waking, it’s usually around 95.6.

I dose my thyroid once a day. I’m considering splitting into 2-3 daily doses though as many patients on natural thyroid replacement have reported feeling better with this split dose. The reasoning is that it simulates the body’s natural, daily release of thyroid.

My TRT is injected twice weekly at 100 mg each injection.

Hi fT3 and low body temperatures when rT3 is rT3 is ‘normal’. This suggests that the rT3 range might be inappropriate.

You could experiment with more NT.

You make your own anastrozole in Vodka if you have the pills.

You missed …

You could ask for 25mcg T3 in a time release compounded product and try that stopping NT. You would need to drive TSH and T4 down and watch body temps. Your case is odd and you will have to experiment with a cooperative doctor.

In regards to the hypo vs hyper symptoms:

Hypo symptoms:
-Rapidly losing outer third of both eyebrows in the last month.
-Constantly low temperature. Rarely above 97
-Digestion issues
-Brain fog
-Easily cold
-Dry, flaky skin
-Brittle nails
-low sex drive (improved somewhat with trt at first, seems to be going back down)
-joint pain

Hyper symptoms:
-Extremely high appetite
-horrible insomnia (coincidentally began two months ago when I switched from naturethroid to armour thyroid)
-I’ll have various nights where I experience large amounts of sweating. I think this is more related to my low e2 though and seems to increase when I take to much arimidex.
-extreme thirst

I dose my thyroid meds once a day at 97.5 mg.

I’m pushing for the T3 option with my current doc. Hopefully she agrees.


Just recieved an email back from my doc. She has agreed to put me on T3!