21, On Thyroid Meds. Low FT, High LH, High SHBG. Read All Stickies

Pharma / TRT Testosterone Replacement
1

I was diagnosed last summer with hypothyroidism. My doctor worked me up to 130 mg of Naturethroid. No matter how high we raise the dose, I have not been able to get my TSH below 2.0.

I’ve had 6 comprehensive blood tests between July last year and my most recent test this past Monday. I won’t post them all here, but common themes of each blood test include:

  1. High Total Testosterone
  2. Off the charts SHBG (most likely caused by thyroid meds)
  3. Higher end, but within range estradiol.
  4. Very low Free T (most likely caused by high SHBG).
  5. Mid-range/normal LH and FSH.
  6. Low range DHEA-S.
  7. Healthy GGT, AST, and ALT

My most recent blood test came back with extremely high LH which has never occurred before. I’m very concerned I may have gonadal dysfunction.

NOTE: I was abstinent for 30 days prior to the bloodwork. (Yes, I’m one of the NoFap guys). My testicles have increased significantly in size throughout the 30 day period of abstinence. This is the only thing I could imagine might affect my LH levels so drastically.

NOTE: All my previous labs have included TSH. For some reason, my doctor forgot to include it on this one but she included all the other thyroid markers. My TSH has remained steady between 2.0 and 2.5. (too high, I know. But no matter how high my doc raised my thyroid meds it wouldn’t come down any lower).

CBC w/differential platelet:

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COMP. Metabolic Panel and Total Testosterone

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Free Test, Thyroxine, DHEA-S, LH, FSH, Estradiol, Reverse T3

Thyroglobulin Antibody, Thyroid Peroxidase, SHBG

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Forgot to mention, I used to play college football and was the biggest, strongest, most ripped guy on the team. Had excellent energy, libido, and confidence.

My libido is shot now. My confidence is low. And my energy is non-existent. I drag myself through every day. I had hoped the thyroid meds would improve this when my doctor put me on them last summer, but the only thing the meds seemed to help improve was my mental clarity (which is still very bad). Coworkers and friends constantly tell me I look “exhausted”. Former teammates have commented on the amount of size/strength I’ve lost since football despite the fact I still train and eat the same way.

My free test has been between 9 and 12 on previous tests. It shot up to 17 this test, but I imagine that’s due to the elevated LH levels.

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Anyone?

4

How many times have you had a blow to the head that took you off of the field? That would link to secondary that you do not seem to have.

Your high LH is why your testes are larger. And LH may be high enough that it is driving higher T–>E2 rates inside the testes. If you used anastrozole to lower E2 and the did not work well, that would tend to prove that hypothesis.

" I still train and eat the same way."
That can be quite hard on the adrenals with low-T and thyroid issues.

rT3 seems ok relative to ranges, but we do see some ranges that would make your level high.

fT4 seems low re mid-range. fT3 is the active hormone and should be tested. Also test ferritin which if low can impede fT4–>fT3.

With adrenal fatigue and elevated rT3, taking T4 meds simply increases fT4–>rT3 and one feels miserable. See thyroid basics sticky and note references to stress, adrenal fatigue, stress, rT3. fT3 and Wilson’s Book.

#Could your thyroid problem be from not using iodized salt? [Doctors never ask]

AST/ALT appear elevated and may be pointing to a problem that may impede E2 clearance and might also in itself increase SHBG production by the liver.

High SHBG means high SHBG+T that inflates TT and SHBG+T is not bio-available.

You have a problem in your testes. A competent doctor should examine for problems.

A test can be made with a couple of T injections. If LH does not come down, there is a defect in the top end of the HPTA where the hypothalamus cannot see T&E2 properly [using a SERM?] or the pituitary has a defect turning on LH&FSH. High sustained LH can turn off the testes if not releasing in pulses. With a single IM injection of 200mg T cypionate, LH/FSH should be turned off in 2-3 days.

List any medications that you have used in the past, Rx or OTC.
BUN can be increased by taking some NSAIDs like ibuprofen long term.

You should try to get on anastrozole to lower E2. Try 0.5mg/week in 0.25 doses twice a week. If E2 does not come down, high LH drivend T–>E2 inside the testes is confirmed. Lower E2 would normally then also be expected to increase LH/FSH and lower SHBG. SHBG lowering may be a slow response under normal conditions.

Labs:
When energy levels are low, AM cortisol needs to be tested, do at 8AM or within 1 hour after waking up.
fT3 is absolutely needed
Post AM and afternoon body temps
BP and pulse.
Semen test to eval swimmers.
fasting cholesterol - can be too low
get testes examined, perhaps ultrasound.

Your case presents a number of challenges that might be best dealt with by a good endocrinologist, but that is rare with male hormone issues. An enthusiastic GP could follow my suggestions.

You state low DHEA but lab is high. Supplementing how much. In some guys, DHEA seems to DHEA–>E2 inside the adrenals. Try to get lower. You said good AST/ALT but labs are high. Take a break from training, recover muscles and muscles should not be sore for lab work.

In the future, you may need to ping me in the KSman is here thread.

Please eval overall thyroid function via last paragraph in this post.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • 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.

5

KSman,

Thank you for the response. I never had any blows that took me off the field. I was strong and big, but I wasn’t a great athlete and didn’t see a lot of playing time.

  1. I’m confused about my LH. My LH has been mid-range/normal on the last 5 blood tests I’ve had. Why would it suddenly skyrocket like that? It’s been around 6.0 on the last several blood tests I’ve had.

  2. I’ve read Wilson’s book and could relate to many of the symptoms of adrenal fatigue. I’d like to get off my thyroid meds in the long run. In Wilson’s book, he discusses how thyroid meds can further complicate existing adrenal fatigue problems. For me to begin curing adrenal fatigue, should I wean off the thyroid meds first?

  3. I use iodized salt regularly for the purpose of supporting my thyroid. My TSH has remained the same with slight fluctuations. I’ve considered iodine drops, but I’m seeing many reports online that iodine supplementation can actually worsen thyroid issues?..

  4. I do not take any medications other than thyroid.

  5. I do not use NSAIDS.

  6. I have arimidex on hand and will begin dosing .25 twice as week as you suggested.

  7. Regarding cortisol, my doctor performed a salivary cortisol test in the past with measurements taken 4 times throughout the day. My cortisol was in range, but it was on the low end in the morning and the high end at night (another symptom of adrenal fatigue discussed in Wilson’s book).

  8. I’ve had my testicles examined in the last year due to a varicocele which I had surgically corrected. The surgeon did not notice any abnormalities other than the varicocele. However, my swimmers prior to surgery were low.

  9. My DHEA has been in the low/below normal range in my previous tests. I upped my daily dosage from 100 mg to 200 mg after reading some old posts by you stating some people need more than others and that you respond well to 250 mg a day (or was it 300? correct me if I’m wrong).

  10. My ALT/AST numbers have been well within range for all of my previous blood tests. This is the first test where they’ve been elevated. I’ll look into a liver cleanse.

  11. I’ll look into the thyroid thread further and perform the body temp tests.

Thank you sir.

6

UPDATE: It’s afternoon over here. Just took my temp and it’s 98.0.

Even after beginning thyroid meds, my temperature has remained consistently low.

7

UPDATE:

Went and saw a TRT doc in the DFW area about 3 weeks ago (a few days after I started this thread).

I showed him my most recent labwork as well as the previous 4 lab tests. He was very friendly, helpful, and listened attentively to my concerns. He agreed my SHBG and free test were a problem…

He asked me if I’d considered HCG mono or Clomid. I responded that I didn’t think that would be beneficial since my LH and FSH did not indicate secondary hypogonadism/pituitary issues. He thought for a minute and then agreed and offered, “So would you like to start a TRT protocol?”

I told him that if all else fails, I’ll go the TRT route but that I’d like to try an aromatase Inhibitor first as KSman recommended and see if it affects my SHBG/Estradiol/Free test significantly. He agreed that was a great idea and told me to take the Aromatase inhibitor for 4 weeks, get bloodwork, and then come back and see him.

I started off with 6.25 mg of prescription Aromasin/day for the first 2 weeks and noticed absolutely no improvement. I increased my dose at the beginning of week 3 to 12.5 mg/day. Since then, I think I MIGHT have experienced a very, very slight increase in libido, but I can’t be sure. My pumps during workouts have gotten progressively worse though. It feels like my muscles aren’t even working when I exercise. My strength levels are good and have remained steady, but my muscles feel flat and dead. Other than that, I’ve noticed no benefit/negatives from the aromasin. I’m getting bloodwork done Monday to see what (if any) effect it has had.

I spoke to my main doctor and we both agreed that I have some level of adrenal fatigue based on old bloodwork. We lowered my thyroid dosage this past week and i feel EXPONENTIALLY more energetic in the past few days. I suspect I should have focused on my adrenals first instead of starting thyroid meds over a year ago.

I have also added selenium/iodine to my daily supplementation, so that may be effecting energy levels.

Finally, I’ve added transdermal Pregnenolone in an effort to raise morning cortisol. Think I may be noticing slightly improved energy/mental clarity, but it’s to early to tell.

MOVING FORWARD:

-Getting bloodwork Monday to survey the effects of the aromasin
-Getting a more extensive panel (mainly for thyroid and cortisol) done at the end of May by my main doctor. I would do it sooner, but she wants to wait until then and see how the iodine/selenium + the pregnenolone affect my levels.

8

Your test and Free T seems to be in normal range other than shbg

9

My free test has hovered between 9-12 pg/mL on the 5 previous blood tests I’ve had prior to this one.

The only reason my free test even reached 17 on this most recent test is due to my skyhigh LH. My LH came back at 13, so of course my free test is going to be somewhat higher in response to such an abnormal LH value. Additionally, an LH value of 13 would usually merit a much higher Free T value than just 17 pg/mL based on bloodwork reports I’ve been examining on other forums. (Someone correct me if my reasoning behind this is flawed).

As KSman mentioned, something is abnormal that the LH values are that high and it signals something is wrong with the testicles. My doctor agreed as well.

Assuming I just hit an abnormal pulse and my LH returns to normal on future bloodwork, there’s no reason to expect my free testosterone won’t drop back down to previous values of 9-12 pg/mL. We shall see.

Regarding total testosterone numbers, that is of little value considering SHBG is so high and is falsely inflating Total Testosterone numbers. KSman has pointed this out in multiple previous threads I’ve dug up.

10

Agreed completely, if that is the case you should get scan of testes to rule out physical abnormalities. We have similar levels but your SHBG is high at this point may be it will become low when LH comes to your normal levels.
In my case e2 is high due to which my SHBG is also high similarly your e2 also is higher at these levels which is causing SHBG to be high.
Being hyperthyroid also causes high SHBG check your dose of thyroid medicine.

11

Your numbers in the first post aren’t entirely dissimilar to mine, except my total testosterone is 200 to 300 points lower.

According to the calculator at ISSAM your free testosterone is 12.6 pg/mL, which is closer to your historic levels. I’ve got a feeling that direct measurements can be problematic.

There’s evidence that low (calculated) free testosterone can be used to diagnose hypogonadism, but the cut off researchers used is 6.5 pg/mL, which is about half your level.

Where I think might be worth digging into are your LH and FSH levels. Compensated or subclinical hypogonadism is when these are high, and your testosterone levels are normal. (See the ISSM and the Nebido site for more.)

In my case (and possibly yours), whilst testosterone levels look fine, the high LH and FSH levels indicate that my (and your) body needs more, but cannot produce it.

12

I’ve been to an endo who examined my testicles manually and saw no problems. Probably need to get an MRI done too. I do have a varicocele on my left side that I had operated on last year. I think it has started to come back a little. While the medical literature does point to the ability of varicoceles to lower testosterone somewhat, the effects do not seem to be significant, especially in the case stories I’m reading throughout online forums.

My SHBG has remained high on all my previous bloodwork even back when my LH was normal.

My E2 is high, but is 37 pg/mL really high enough to warrant a 55 level SHBG? Usually, when SHBG is caused by high estradiol, estradiol tends to be much higher.

I have a feeling my thyroid meds are playing in a role in raising SHBG for sure. From what I’ve gathered in my reading, this can be attributed to low cortisol. The body’s primary method of Testosterone regulation is cortisol. When the body can’t produce sufficient cortisol levels, it resorts to SHBG/and or estradiol to regulate Testosterone levels. Thyroid meds strain the adrenals, thereby lowering cortisol, thereby causing the raised SHBG. At least, that’s the theory I’ve heard thrown about on allthingsmale.com and steroidology.com. Definitely seems it could be plausible. Maybe it’s just shooting from the hip though.

13

Try to lower your thyroid medicine dose and see where SHBG stands. For 37 E2, 55 SHBG is quite high in my case e2 was 32 then SHBG was 40 only. So there is certainly thyroid medicine role here maybe dose is higher than required.

14

Talked to my primary doc about it last week, and she lowered it from 130 mg/day nathrethroid to 97.5 mg/day. Gonna test again in May. Haven’t taken my thyroid meds in the last 4 days due to not having time to stop by the pharmacy, and I feel better than I have in months. Really think the thyroid meds have been exacerbating my low cortisol problem.

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