T Nation

31, Thinking of TRT, Opinions Before Bringing Up with Doctor

Between my lab results, weight gain, trouble sleeping, general “meh” attitude about life, gynecomastia and hair loss at young age - among other things - I want to talk to my doctor about TRT and want to be as prepared as can be.

  • 31 years old (30 at time of testing).
  • 5’ 7". 220lb. ~30% body fat
  • 36" waist.
  • Started going bald at around 21 (every male member of my family is bald).
  • Issues with gynecomastia starting back in high school, getting worse around 21.
  • Barely any chest or back hair. Can grow a decent beard.
  • Carry a lot of fat in the stomach / love handles and thighs.
  • Few surgeries (broken bones)
  • No health conditions
  • No prescriptions in the past. On adderall now, but was not on it when the tests were taken.
  • I do a lot of heavy weight lifting, so I eat plenty of grass fed red meat, lots of grass fed whole milk, and a decent amount of carbs. No general diet restrictions / issues that I am aware of.
  • Barbell strength training 3x per week since October 2016 (Squat, Bench, Dead, Bench Press, Overhead Press).
  • Right teste aches more days than not.
  • Occasional morning wood (few days a week)

Lab results with ‘high risk’ ranges in parentheses. Labs were ordered from Wellnessfx.com and were taken at a quest diagnostics.

TSH (< 0.45 or ≥ 4.21)
7.63 mlU/L
T3 Total (< 0.45 or ≥ 4.21)
77 ng/dL
Free T3 (< 2.3 or ≥ 4.2)
3.3 pg/mL
T Uptake (< 20 or ≥ 40)
T4 Total (< 4.5 or ≥ 11.8)
6.5 ug/dL
Free T4 (< 0.81 or ≥ 1.78)
1.3 ng/dL
Reverse T3 (< 0.81 or ≥ 1.78)
14 ng/dL
Estradiol (< 12 or ≥ 39)
22 pkg/mL
Total Testosterone (< 290 or ≥ 1301)
275 ng/dL
DHEA-S (< 160 or ≥ 450)
280 ug/dL
Free Testosterone (< 46 or ≥ 224)
70.3 pg/mL
SHBG (< 10 or ≥ 51)
12 nmo/L

Just to get you ready for this … this is the worst thyroid labs I have ever seen here. Never seen lab ranges with this backward ‘high risk’ notation.

TSH should be closer to 1.0
T3, T4, fT3, fT4 should be mid-range or a bit higher
rT3 should be mid-range

tT3=77 - really?
rT3=14 ?

You have hypothyroidism that seems to be heavily driven by rT3 and rT3 is driven by adrenal fatigue.

Thyroid lab ranges are quite useless, go with what I suggest.

We need to see the net effect of those levels and you are going to do that via the last paragraph in this post.

fT3 is good at mid-range and should support good body temperatures, but temps are expected low with fT3=3.3 and rT3 high.

SHBG is very low and we need to look at fasting cholesterol and A1C to see if that is been driven by insulin insensitivity or diabetes.

Please post all of your labs.

With low T, we need to know LH/FSH to identify cause if possible. Also test prolactin which can key into all of your symptoms. Has your peripheral vision decreased? Should be around 180 degrees wide.

Do you feel cold easier now?
Are outer eyebrows sparse?

#Please double check your labs above for typo errors.

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.

Hi KSman, and thank you for taking your time to reply.

With a bit of formatting, I was able to turn my test result in to the below table. This should clear up any typos, as well as show all of the results. These tests were taken in the morning, around 9AM, while fasting.

I’ll make sure to get those additional tests done the next time I am in the lab - probably next month, but maybe sooner.

No noticeable decrease in peripheral vision, and I had my last eye exam a few months back.
I don’t think I feel cold easier now than I used to.
My outer eyebrows seem about as busy as always.

My oral temperature as just measured was 98.0f, and then again at 98.1f. I did however eat about 30 minutes prior to the test, so I’ll retest in the morning.

Additionally, I’ll make sure to read all of the relevant stickies in the morning.

Test Description Result Measurement Range
Total Cholesterol A Type of Fat 199 mg/dL 125-200
HDL """Good"" Cholesterol" 55 mg/dL > OR = 40
Triglycerides Type of Fat 92 mg/dL <150
LDL Less Healthy Low-Density Lipoprotein 126 mg/dL <130
Total to HDL Ratio Total Cholesterol to HDL Ratio 3.61818181818182
Non-HDL Cholesterol (Calculated) All Less Healthy Cholesterol 144 mg/dL
Glucose Blood Sugar 92 mg/dL 65-99
BUN Blood Urea Nitrogen 15 mg/dL 7-25
Creatinine Creatinine in your blood 1.2 mg/dL 0.60-1.35
eGFR Marker for kidney function 81 mL/min/1.73m2 > OR = 60
eGFR (African American ethnicity) eGFR if African American 94 mL/min/1.73m2 > OR = 60
Sodium An electrolyte outside cells 140 mmol/L 135-146
Potassium An electrolyte inside cells 4.4 mmol/L 3.5-5.3
Chloride Balances other electrolytes 107 mmol/L 98-110
CO2 Carbon dioxide in blood 22 mmol/L 19-30
Calcium Blood and Bone Mineral 9.7 mg/dL 8.6-10.3
Total Protein Total protein amount (serum) 7.1 g/dL 6.1-8.1
Albumin Type of protein in blood 4.5 g/dL 3.6-5.1
Globulin Immune protein 2.6 g/dL 1.9-3.7
A/G Ratio "Proportion, albumin/globulin" 1.7 1.0-2.5
Bilirubin (total) Made by the liver to help digest fat. 0.6 mg/dL 0.2-1.2
ALP Alkaline Phosphatase 65 IU/L 40-115
AST / SGOT Aspartate aminotransferase 19 IU/L 10-40
ALT / SGPT Alanine aminotransferase 38 IU/L 9-46
Iron (serum) Iron in liquid part of blood 99 μg/dL 50-195
Total Iron Binding Capacity Estimates Transferrin level 363 μg/dL 250-425
Iron Saturation The percent of Iron transport protein bound to Iron 27 % 15-60
RBC Magnesium The Magnesium in our cells 4.8 mg/dL 4.0-6.4
Apo B "Protein in LDL (""Bad"") Cholesterol" 91 mg/dL 52-109
Insulin-Like Growth Factor I A Measure of Growth Hormone 232 ng/mL 63-373
Z score IGF-1 compared to others 0.9 -2.0 - +2.0
Lp(a) Different Form of LDL 291 nmol/L <75
White Blood Cell Count Immune system cells 8.7 x10E3/μL 3.8-10.8
RBC Red blood cell count 5.33 x10E6/μL 4.20-5.80
Hemoglobin Protein in red blood cells 15.8 g/dL 13.2-17.1
Hematocrit Fraction of red blood cells 47.6 % 38.5-50.0
MCV Mean corpuscular volume 89.3 fL 80.0-100.0
MCH Mean cell hemoglobin 29.6 pg 27.0-33.0
MCHC RBC hemoglobin concentration 33.2 g/dL 32.0-36.0
RDW Red cell distribution width 13.4 % 11.0-15.0
Platelet Count Clot-forming cell fragments 288 x10E3/μL 140-400
Mean Platelet Volume (MPV) Average platelet size 8.6 fL 7.5-11.5
Neutrophil Count (ANC) Type of white blood cell 5.09 x10E3/μL 1500-7800
Lymphocyte Count (absolute) Calculation of WBC type 2.558 x10E3/μL 850-3900
Monocytes (absolute) type of white blood cell 0.539 x10E3/μL 200-950
Eosinophil (absolute) Calculation of WBC type 0.444 x10E3/μL 15-500
Basophil (absolute) Calculation of WBC type 0.07 x10E3/μL 0-200
% Neutrophil Part of WBC differential 58.5 %
% Lymphocytes Part of WBC differential 29.4 %
% Monocytes Part of WBC differential 6.2 %
% Eosinophils Part of WBC differential 5.1 %
% Basophils Part of WBC differential 0.8 %
hs-CRP General Inflammation Marker 1.4 mg/L
Cortisol Primary stress hormone 9.9 μg/dL
DHEA-S Adrenal Hormone 280 μg/dL 85-690
Ferritin Iron storage protein 94 ng/mL 20-345
Folate Folic Acid 13.3 ng/mL
Insulin Blood sugar storage hormone 7.3 mIU/L 2.0-19.6
Vitamin B12 Essential nutrient for cells 570 pg/mL 200-1100
TSH Thyroid-Stimulating Hormone 0.84 mIU/L 0.40-4.50
Estradiol Main female sex hormone 22 pg/mL < OR = 39
25-Hydroxy Vitamin D Precursor to vitamin D 33 ng/mL 30-100
Hemoglobin A1c (HbA1c) Average blood sugar level 5.4 % <5.7
SHBG Sex Hormone Binding Globulin 13 nmol/L 10-50
Testosterone (total) Steroid hormone 282 ng/dL 250-1100
Free Testosterone Active Unbound Tesoterone 73.3 pg/mL 35.0-155.0
Triglycerides to HDL Ratio Ratio of Triglycerides to HDL 1.67272727272727
HOMA-IR SCORE Predicting risk of insulin resistance and diabetes 1.7
Weight Your weight 203 pounds
Body Mass Index Measure of weight to height 31.8 Kg/m2
Waist Circumference The circumference of your waist 34 inches
Waist to Height Ratio The ratio of waist to height 0.507462686567164

Thanks again!

Temperature this morning is 97.3, retested at 97.4.

97.4 this afternoon. Going to pick up some iodine and selenium supplements and see if that helps.

Supplementing with iodine has not increased my body temperature, nor has it helped any of my symptoms go away.

My primary doctor dismissed my case as “normal” and was not interested in further exploring the subject.
The next doctor lined up fell through and won’t be able to see me until at the earliest this winter.

Your complete blood work was really good.
Maybe you could use a bit more iron in your diet. Red meat.

Your diabetes risk is based on your % body fat. Related labs are good - so far.

What iodine and selenium supplements?

You were feeling cold?

KSman is correct about the seriousness of the thyroid issue. My go to thyroid info site www.stopthethyroidmadness.com points to both your Rt3 and Iron levels being potential problems for you. https://stopthethyroidmadness.com/reverse-t3/

Hope that helps.

I originally thought that KSman’s comment ‘worst thyroid labs’ was regarding the ‘backward high risk notation’, not about the results of the labs themselves.

Am I wrong, or are my thyroid labs are really that bad?

I am currently eating between 1 and 2 lb of grass fed red meat per week ; it wasn’t as much back when these labs were taken, however.

I took 3 iodoral (12.5mg) tablets for 3 days (monday - wednesday), and then 1 tablet each on thursday on friday, for a total of 11 tablets or 137.5mg over 5 days. Since then I’ve been taking the ‘kelp’ supplements, which are a very low dose but figured those would be sufficient for maintenance.

After the second week of taking the kelp supplements, I stopped as I want my labs to represent my normal levels.

I did notice that when taking the 3 tablets each day, I would become /extremely/ lethargic & brain-fogged, to the point of being couch locked, a few hours after taking them.

That has been happening to me on and off for years, but only ‘intermittently’ happened, and not very often.

I’ll post the selenium and kelp dose later as I can’t recall it.

While of course subjective, I’ve always handled the cold very well. I don’t believe my eyebrows are sparse.

With a T3 of 77 ng/dl and a RT3 of 14 ng/dl, my ratio is 5.5, which is apparently very low.

Using the free T3 lab instead, of 3.3 pg/mL, my ratio is 23.6, but I assume the ratio is for T3 and not free T3?

Awesome news too - found a great local doctor that specifically deals with TRT / HRT / Thyroid issues / etc - Dr. Terry Grossman at http://www.grossmanwellness.com/. I have my first appointment scheduled for the 17th.

Had my appointment today. The doctor (well, nurse practitioner) said 1) my
"testosterone levels are very low", whatever specifically that means, 2) my thyroid labs are look OK and thus I don’t have hypothyroidism and 3) order a new set of labs since the old ones are a year old.

The NP is very willing to work with me, so that is fantastic news, at the least.

I didn’t bring my comprehensive notes, and I am recovering from a 3-day weight lifting seminar and was low on sleep, so I didn’t have the knowledge on hand to argue about #2. Instead, I had new labs drawn and when I come back with the results, I’ll be more prepared to stand my ground.

NP said that at if my labs were more recent, she’d be setting me up with TRT today, but nothing about the thyroid. When I quizzed her about the TRT protocol, she passed (T cypionate or ethanate, hCG, and anastrozole, as opposed to just T).

So, she is on board with TRT, but needs some convincing about thyroid.

Got the following labs drawn today:

  • LH and FSH
  • TT
  • FT
  • E2
  • Prolactin
  • PSA
  • TSH
  • fT3
  • fT4
  • Iodine
  • Vitamin D
  • DHEA-S

Will check back in after the appointment / lab follow-up, in about 2 weeks.

Looks like a promising start.

You may be trapped by the thyroid lab ranges that mean that only by definition can a few percent be abnormal as this is a mathematical statistical construct and doctors need to think outside 3 standard deviations.

Do you have current body temperatures? AM and mid-afternoon? Body temps are the net effect of all of these different thyroid hormones.

That happened to me the first few days of Iodine Replenishment. Might have to do with bromine being cleaned out?

Have not seen many reports re flushing out bromines, but it does happen. The one good case reported here also involved the guy stinking of bromines which is like dead fish. A wife or GF will pickup on that quickly.

Was tracking my body temps last month and they never got past 97.4 (see posts on Jun 15).
My current temp is 98.0 I am unsure why it has risen - I haven’t changed anything in the last month.

Perhaps some general recovery aided by the kelp and selenium, “possible” bromine clearance.

Labs are coming back pretty quick. Had FSH, LH and Prolactin taken at the doctor’s office (they send over to labcorp but charge less) then the rest out at labcorp.

  • LH: 6.0 (1.7-8.6 mIU/mL)
  • FSH: 2.4 (1.5-12.4 mIU/mL)
  • Prolactin 8.1 (4.0-15.2 ng/mL)

I’ll update hopefully tomorrow with the rest of the labs.
Body temperature 97.4 this morning.

About to lose my cool. Got the rest of the labs back and it looks like they forgot to test for testosterone (free or total). Great, another week wasted.

  • fT4 1.05 ng/dL (0.82 - 1.77)
  • fT3 2.9 pg/mL (2.0 - 4.4)
  • DHEA-S 295.8 ug/dL (138.5 - 475.2)
  • TSH 1.060 uIU/mL (0.450 - 4.500)
  • E2 20.2 pg/mL (7.6 - 42.6)
  • PSA 0.8 ng/mL (0.0 - 4.0)
  • Iodine 43.0 ug/L (40.0 - 92.0)
  • Vit D 30.5 ng/mL (30 - 100)

I have a followup appointment tomorrow. Considering they forgot to take the Testosterone labs, I doubt they’ll have me start TRT protocol tomorrow.

What do my last set of labs tell you?

Looks like both my fT3, fT4 and TSH labs are around mid-range, which is what you said they should be.

How do the rest of the labs look?

Not sure what my goals for tomorrow’s appointment should be.

At this point I’m uncertain if I have a thyroid issue (would have been nice to have the rT3 done last week).

Based on my previous labs, I certainly have low testosterone, though I was thinking that to be caused by hypothyroidism, which may not be the case.

What do you think? Where am I at now / what should my goal for tomorrow’s appointment be?

Office caught LabCorp’s mistake and had them run the Testosterone tests against the same sample from last week (how long do they keep my blood around anyway?), so appointment rescheduled for Wednesday.

TSH is a good number. fT4 is below mid-range, typically suggesting that iodine might be lacking. fT3 is below midrange=3.2
fT4–>fT3 seems in balance, at least not impaired.
Odd that TSH is not higher.

Keep looking for patterns in AM and mid-afternoon body temperatures.

FSH is often a better indicator of LH status than LH itself.
Iodine=43.0 is a spot test and might not be the whole story.

If iodine deficient for years, thyroid nodules can develop that change the relationship between TSH and the other thyroid levels and TSH can be lower than expected.