T Nation

28 Y/O - Bloodwork and TRT Advice


#1

Age 28
Weight 80kg
Height 183cm

I first went to an Endo (UK) earlier this year after years of perceived low T symptoms such as brain fog, fatigue, severe anxiety (health anxiety specifically), poor sleep, skinny fat.

I had been on a 500mg cycle of test e for 10 weeks back in 2016 with nolva as pct, I regret this immensely given the below findings.

I had bloods and an MRI taken of my pituitary which came back showing a micro adenoma. Suppression test was performed and the adenoma is believed to be non-secreting. I was also found to have a minor enlarged prostate but no nodules or sign of cancer. I also had a varicocele embolisation earlier this year. Testis are 10-12mm for the left and 12-15mm on the right.

The Endo perscribed test gel but I have yet to start as I would like to have a family and uncertain whether trt will complicate things further.

Recent fasted morning blood work with lab ranges are below:

TT - 12.2 nmol/L (7.6 - 31.4)
FT - 6.7 pg/l (4.0 - 30)
LH - 3.3 IU/L (1.7 - 8.6)
FSH - 7.9 IU/L (1.5 - 12.4)
SHBG - 27 nmol/L (16 - 55)
Free Thyroxine - 17.5 pmol/L (12 - 22)
Free T3 - 6.0 pmol/L (3.1 - 6.8)
TSH - 4.93 mIU/L (0.27 - 4.2)
Vit D - 78 nmol/L (50 - 200)

Fasting blood glucose - 6.2 mmol/L (3.9 - 5.8) * could be high due to anxiety at the time.

Kidney, liver and blood markers came back fine, can put other results in the thread if needed

My mother has hypothyroidism, my thyroid has never had an abnormal reading until here where TSH is higher than usual.

I’ll buy a thermometer to take readings, however, right now I’m all over the place. The stress and anxiety I’ve been through since this diagnosis is overwhelming my life and uncertain what the best course of action is.


28 Y/O Bloodwork - Uncertain Whether to Start TRT
#2

Don’t beat yourself up, that did not hurt you.

If I were you, I would go with testosterone injections and hCG. I’d get a baseline estradiol level too. As for thyroid, yes, you need to address it. Free T3, free T4 and reverse T3 tests are needed.


#3

Updated OP, t3 / t4 were free levels, not sure what reverse t3 is so will have to look that up.

The NHS Endo has prescribed gel, he said when I’m trying for kids he’d prescribe hcg but wouldn’t want to give it long term.


#4

In that case, you really need reverse T3 evaluated. Briefly, it’s an imperfect version of T3 which does not work, but it does block the receptor site from normal T3 and keeps it from working. You have a good level of fT3, but your brain thinks you need more and is producing a higher level of TSH to try to get it.

Regarding the hCG, that’s reasonable. I’d run it a couple of months a year regardless, then go to it full time when you’re ready.


#5

You definitely have hypothyroidism that your doctor seems have completely missed, Reverse T3 will explain elevated TSH as Reverse T3 slams on the brakes metabolically. Test Gel usually provides sub par levels and men with hypothyroidism don’t absorb tropicals at all.

Surely your doctor is concerned about TSH being out of range? This is an indication of a struggling thyroid so further investigation is warranted.

Suggest going private for TRT, a lot of endos just don’t know how to do TRT well.


#6

That was a private Endo from Harley Street, cost a bomb too! He wants to take bloods again in 2 months in case it was an anomaly, however private is so costly, over 1k for 2 appointments and some bloodwork!

I’m seeing my NHS Endo in 2 weeks with thyroid bloods taken next week, hopefully he’ll be able to investigate further.

If they manage to control the thyroid do I still need to begin TRT? I’m assuming that’s a loaded question with many ifs, I’d just like to gauge how treatment would look for such a condition.


#7

Yes you will still need TRT. As far as the NHS endo, not such a great idea as the play the numbers game, in range are you’re fine, out of range and you get TRT.

NHS is a waste of time, even if by some miracle you get TRT, their protocols are stupid. NHS endo’s are a lost cause when it comes to replacing hormones.

You will have to twist your endo’s arm to get the Reverse T3 tested as it’s expensive.


#8

The NHS Endo was willing to prescribe testosterone, but only in gel form. I’ll use next fortnight’s appointment with him to pursure a reverse T3 test and to see if he’ll give injectable testosterone.

Interesting you say men with hyopothyroidism do not respond well to topicals, I’ll have to bring that up with him (we all know doctors love being told things they probably don’t know!).


#9

He will refuse Injectable Testosterone most likely it’s an NHS Endo we talking about here brother. Best to pay Private to get a Private Prescription for Injectable, then you can find the best type of testosterone for your health Bro. @uhtred


#10

Another point about the offering of T-gel only, T-gels are very profitable because the delivery system is patented, injectable testosterone isn’t therefore not a money maker, I believe money is the reason why only Gel was offered.

In any case he doesn’t have your best interests at heart.


#11

I first went to an Endo (UK) earlier this year after years of perceived low T symptoms such as brain fog, fatigue, severe anxiety (health anxiety specifically), poor sleep, skinny fat.

I had been on a 500mg cycle of test e for 10 weeks back in 2016 with nolva as pct, I regret this immensely given the below findings.

I had bloods and an MRI taken of my pituitary which came back showing a micro adenoma. Suppression test was performed and the adenoma is believed to be non-secreting. I was also found to have a minor enlarged prostate but no nodules or sign of cancer. I also had a varicocele embolisation earlier this year. Testis are 10-12mm for the left and 12-15mm on the right.

The Endo perscribed test gel but I have yet to start as I would like to have a family and uncertain whether trt will complicate things further.

Recent blood work with lab ranges are below:

TT - 12.2 nmol/L (7.6 - 31.4)
FT - 6.7 pg/l (4.0 - 30)
LH - 3.3 IU/L (1.7 - 8.6)
FSH - 7.9 IU/L (1.5 - 12.4)
SHBG - 27 nmol/L (16 - 55)
T4 - 17.5 pmol/L (12 - 22)
T3 - 6.0 pmol/L (3.1 - 6.8)
TSH - 4.93 mIU/L (0.27 - 4.2)
Vit D - 78 nmol/L (50 - 200)

Fasting blood glucose - 6.2 mmol/L (3.9 - 5.8) * could be high due to anxiety at the time.

Kidney, liver and blood markers came back fine, can put other results in the thread if needed

My mother has hypothyroidism, my thyroid has never had an abnormal reading until here where TSH is higher than usual.

I’ll buy a thermometer to take readings, however, right now I’m all over the place. The stress and anxiety I’ve been through since this diagnosis is overwhelming my life and uncertain what the best course of action is.


#12

Those testosterone levels are poor for a 28y/o. You need testosterone. You can use hCG to maintain fertility. Were the T3 and T4 tests for free or total? You need reverse T3 tested. A TSH of 4.93 is not good.


#13

Those are free T3/4 results, when I see the NHS Endo I’ll ask for reverse T3, if he refuses I’ll have to ask my private Endo.


#14

Yeah, something is up, good free T3/T4 yet your pituitary is pumping out excess TSH in an attempt to get more.


#15

Could be the pituitary adenoma.


#16

Without knowing historically where your levels were at when you were feeling good, it’s possbile that your “normal” range was a bit higher before you started having issues. Your elevated TSH is a little out of place, but is it possible that your body is just trying to bring your ranges back up to a higher range that is normal for you? If so, then TRT should be of some help but I’d bet that your dosage is going to be a little higher than most for proper stability. I’d be a little worried about the enlarged prostate, especially in light of doing TRT, and would keep a very close eye on it. If that ever starts developing into a situation where cancer is present then the TRT can actually accelerate the growth…not good!

You can try taking a zinc and magnesium supplement to bring your SHBG down just a bit. This could bring the FT numbers a little higher and see if you stabilize a bit more. You would probably also be well advised to rid yourself of as much stress and anxiety as possible (lifestyle evaluation and changes).