T Nation

29 y/o - Low T, Elevated TSH. Pituitary? Results

6’4", 297.2 Lbs (30% BF)
Body fat mostly focused in a sagging midsection, but also in my triceps and thighs.


  • Asthma
  • Gyno from birth. Father also had an issue. (Surgically corrected at 16)
  • Started puberty at four years old. Was taken to an endocrinologist then and everything said to be normal. Went grey in my early 20s.
  • Was generally a fat kid and teenager, but had a major spike in my early 20s and went up to 324 Lbs at >40% BF through diet and inactivity. Have had successful cuts and have been as low as 217 Lbs/17% BF.
  • Thyroid was a concern as a teenager, but labs returned normal. Otherwise lived “normally” until recently.
  • Acid reflux, GERD.

Symptoms include virtually no libido (haven’t had sex to completion in over five years and had to take matters into my own hands to have an orgasm with my last partner), erectile dysfunction (lost morning wood probably close to 10 years ago, have never had spontaneous erections in my life, and have had extreme difficulty keeping it up during sex), ejaculatory problems (both delayed and can sometimes be accompanied by sharp, razor-like pains recently), chronic pain/swelling in my feet and legs, and new issues with chronic fatigue to the point I’m sometimes sleeping entire days at a time, decreasing appetite, and poorer eyesight. My moods are generally angry and can sometimes be violently explosive when I have the energy.

Diet is crappy. I’ve lived mostly on pizza, ready made sandwiches from the grocery store, and chocolate for the past year. At the minute, I eat takeout food at work nearly four times a week. Before this year, I was mostly eating clean. No alcohol.

Currently have little supplement intake: 5g creatine mono on training days and a multivit daily. However, I am a heavy caffeine user. Formerly used 800mg-1g daily when I was doing keto (two years ago). Currently somewhere between 150-400mg as and when needed, which is every few days. Sublingual ROA. Only asthma inhalers and daily antihistamine as rx intake.

Training is very hit and miss at the moment and is largely dependent on fatigue levels and if I’m actually awake to be in the gym. I’m mostly on a standard push, pull, legs routine with mixed results when it comes to heavy training. Some days I can make progress. Others I’m back to bare beginner territory. Formerly 4 on 2 off for nearly three years.

Lifestyle bears an additional mention: I currently work a full time night shift in a casino and was the sole caregiver for a family member with stage 4 cancer since January until their death in August. I didn’t have any respite care and was effectively on-duty 24/7. I often lost sleep; sometimes for three or four days at a time and I’d use caffeine very heavily on these days just to function. I also almost completely gave up lifting this year to care for them, but didn’t really have much strength to lift in the first place and was too worried when I left them anyway. My sleeping took months to correct, but is now plagued with sleeping for entire off days from work, getting up at 4 AM and staying up until noonish before sleeping until the evening, and/or needing long naps to get through the day. I’ve fallen asleep in public on two separate occasions within the past few weeks, too.

Labs (12h fasted results):

I went to a GP about my symptoms and TSH after getting the first batch of results. He told me “normal means normal” because my labs fell within the range. He wasn’t considered about my high uric acid levels, which I thought could be behind my foot pain, and expects things to normalize with better diet and lifestyle changes. I dug a little deeper with another private lab about a month after that and found my sex hormones are going in the toilet, too.

Here’s where I stand: should I pay for a private appointment with an endocrinologist right now or should I go on a cut, redo the labs, and then reassess what to do? Obviously I know I’m not doing my body any favours by living on junk food and having a crappy sleeping pattern, but my symptoms are hardly new for the most part and have followed me through various physical stages, so I don’t think the right answer is the simplest one here. However, I doubt I’m a good candidate for TRT or other hormone therapy by carrying high bodyfat levels around, so is an endo just wasted money right now? I don’t know. It’s my fatigue that’s concerning me the most since it’s stopping me lifting.

Any possibilities I should look into and bring up with the doctor when I get in?


You appear to be hypothyroid. Need to fix thyroid first before cut or TRT. should do labs on anti-bodies for thyroid. please read stickies on thyroid. check basal body temperature in the morning before you get out of bed. chk the sticky for iodine info if you dont have iodine in your diet.

You are hypothyroid, most experienced doctors will start treating the thyroid when you go above 2.5 uU/mL. The problem with most doctors is all these lazy bastards have to do is look at a bunch of numbers on a piece of paper and say you’re normal even though you are having symptoms of hypothyroid given your history. These doctors are brain dead and don’t have deductive reasoning, it’s easier for them to look at a piece of paper than actually attempt to use that thing they call a brain. Hospital doctors will behave like this, their interested in seeing as many patients as they can spending the least amount of time per case, private practices don’t typically triage people in this manner.

Your T of 236 ng/dL is dangerously low and the cutoff point for many nasty diseases is below 440 ng/dL. Good doctors outside the USA are extremely touch to find, most doctors wait for you to reach disease status, in other words they wait for things to get 100% bad before taking any action as you’re finding out as your TSH is getting close to the limit.

Your poor diet is going to end up killing you if you don’t start eating healthy! Don’t let doctors keep saying your normal, you don’t feel normal do you? Find a doctor that will listen, research a competent doctor. The internet is a powerful tool!