T Nation

36 YO Male Needs Feedback


#1

Age - 36
Height - 6'1
Waist - 32
Weight - 180
Body fat - 13%
Facial hair and body hair - light beard, very little body hair (part Indian and my dad does not have much either)
Diet - eat pretty healthy, meats veggies fruit, not to much processed stuff, no gluten, have not been strict with my diet lately though
Training - Crossfit 3-5 x a week with 2-3 strength components a week before high intensity work out
Symptoms and thoughts - have thought that I might have low t and after researching a reading a little more on HRT I also thought that I might have hyperthyroid due to symptoms of low temperature normally around 98 or below. I also seem to always have cold feet and hands. My libido has decreased in the past few years and energy levels don't seem to be very high. No problems with ED really. Morning wood still happens bit not a regular and not very strong.
Meds - I don't really take any meds other than some topical things for face keeping mild acne cleaned up.

Blood work done on 12/24/14
Estradiol - 12 pg/ml. Range below 63. Doctor thinks this is to low.
DHEA - 124 ug/dl. Range - 103-446. Doctor wants this to be 400-600 ideally. Wants me to take supplement 50 mg a day. Question - will any over the counter DHEA work the same as what my doctor is trying to sell me?
Testosterone - 523 ng/dl. Range 292-1052. Doctor would like to see this 800 or above
SHBG - 75 nmol/l. Range -17-66. Thinks this is way above what it should be.
Calc Free Testosterone - 6.1 ng/dl. Range - 4.8 -25. Doctor thinks this is very low, would really like this closer to 20-25. Wants me to begin with T-cyp - IM 200 mg a week

Glucose - 75. 65-100
Bun 15. 8-25
Creatine 1.1. 0.8-1.4
Egfr non af am - 76. Greater than 60
Calc bun/creat - 14. Ratio 6-28
Sodium - 139. 133-146
Potassium -4.5. 3.5-5.3
Chloride - 107. 97-110
Carbon dioxide - 26. 18-30
Calcium - 10.1. 8.5-10.5
Cholesterol - 185. Less than 200
Triglycerides - 50. Less than 150
HDL - 55. Greater than 39
LDL. - 120. Less than 100
Risk ratio LDL /HDL -2.18. Less than 3.55
Protein - 6.7 g/dl. 6.0-8.4
Albumin - 5.0. 2.9-5.0
Calculated globulin - 1.7. 2.0-3.8. Doc wants me it take something called protease
Calc a/g ratio. 2.9. Ratio - 0.9- 2.5
Bilirubin total - 0.6. .1-1.3
Alkaline phosphatase - 52. 30-132
Sgot (ast) - 15. 5-32
Sgpt (alt) - 13. 7-56

Free T3- 3.3 pg/ml. 2.3-4.2
Free T4- 1.03 ng/dl. 0.73-1.95
TSH - 2.2 uiu/ml. 0.5-4.7. Doctor wants this a little lower. Wants me to begin taking thyroid meds due to symptoms. Does not think it have iodine deficiency because of T3 and T4 levels.

Hemoglobin a1c - 5.6%. 4-5.6

I put some of my doctors thoughts above with blood work. Ultimately really thinks test will be a big help and thyroid. Feedback? QUESTIONS?

I'm trying to decide if I want to proceed and start TRT and HRT. Opinions?


#2

Have you been using iodized salt continuously for years? If not, you could be deficient.
Do you get cold easily?
Please read the thyroid basics sticky and check waking and mid-afternoon body temperatures. [98 or below when?]

Thyroid is enlarged, lumpy or asymmetrical?

No testing of thyroid antibodies for auto-immune disease? - which can be caused by lack of selenium which you can find in some multi-vits.

Any DHEA product will do. Low DHEA at your age suggests an issue with adrenals. Lots of stress in your life or major stress events?

Your fT3=3.3 should allow for good body temps, suggesting that rT3 might be blocking fT3 from entering your cells. Stress and starvation diets can increase rT3 - more in the stickies

If you can improve thyroid function via iodine or Rx meds, some other issues may resolve.

Also see advice for new guys sticky.

Hemoglobin a1c suggests insulin resistance which is odd for your 31" waist. Fish oil can improve insulin sensitivity and cell wall permeability.

Low E2 and high SHBG is very odd. Suggests liver issues, however ALT/AST are good.
""" SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol. “”"

Starvation diets? That would explain some things.

Test rT3 and thyroid antibodies, if no issue with anti-bodies, then you can try iodine replacement dosing.

Where are you located?


#3

Thanks for the response KSman.

I have used iodized salt but have recently used some more mineral salts for some things I eat at home. I feel that I do get cold pretty easily and my hands and feet seem to always be cold. My doctor also noticed that my fingernails have what he called ridges in them. I have had low temps for a long time but I will track the actual temps I’m getting this week. Never really get to 98.6 though.

I have read the Thyroid sticky and specifically asked the dr if he thought it might be iron deficiency and he said he didn’t think so and thought instead that I was hypothyroid or hyper kinda confused which he said. Are there any drawbacks or side effects to getting on a iodine supplement like you detail if you aren’t deficient in iodine?

I have no idea if thyroid is enlarged or lumpy or anything?

No he did not mention thyroid antibodies but I seem to remember something about him mentioning that I could have auto immune disease in future if I didn’t get my levels to a better place. Is selenium a necessary supp?

I definitely have lived with stress for quite a long time with job ECT.

I have never been on a starvation diet, I do sometimes use intermittent fasting. I tend to eat quite a bit however because my activity levels are high and have never had a weight problem at all. More the opposite where I have tried to gain weight via eating and strength training.

So if you were me, would you start iodine before getting on Rx for thyroid?
With my free test levels so low do you think that test therapy would be a good move?

I live in Austin, TX by the way.

I appreciate all the help. Oh also I forgot to include these last time but

Hemoglobin - 15.0 g/dl 13-17 range
Hemocrit - 43.9% 37-49 range


#4

Iodine deficiency or iron deficiency?
Men do not get iron deficiencies unless they have a GI bleed which can be detected with a simple test kit for “occult blood” in stool.

You should not treat an iodine deficiency with a lifetime Rx of thyroid meds.

Test rT3

Get vitamins that list trace elements and stick to iodized salt. Skip the unrefined rock salt minerals.

Body temperatures are the bottom line for thyroid function status. When fT3 is good and temps are low, one needs to check rT3.

Your “case” has many odd aspects. Yes, you would benefit from TRT. But you still need to look for causes where low T is the symptom. Any sometimes TRT does not go well when thyroid function is off.

Your hematocrit would improve with TRT.

If you do IR and body temps improve and you feel improved energy and mental function, then you were deficient. The “question” depends on your history of intake. But one can have adequate fT3 and adding iodine does not resolve the rT3 blocking fT3 from entering your cells. So check your temperatures for a while to see what going on. If you were iodine deficient, others in your home might be too, check temperatures and in any case, always good to see others getting 98.6 when you can’t and then you have more confidence in the thermometer.


#5

Well I have been on iodine replenishment for just about 2 weeks. I have about 2-3 more days. I haven’t noticed much change and still my body temps don’t reach 98.6. I have tried multiple thermometers. I’m normally around 98 in the afternoon and 97.5 or so in the mornings. I feel like my temps have gone up, but not all the way. Energy has seemed about the same.

I have been taking DHEA supplement from lef 50 mg every morning. Selenium every day and 5,000 vitamin d for the past couple weeks as well. I wanted to give my system a chance to right themselves. However, I fee my libido has decreased further and virtually no morning wood at all especially as I have been paying attention.

Not sure how long I should wait for another blood test. Any other recommendations???


#6

Hey man I feel your frustration and worry. Figuring all this stuff out is crazy and confusing tonthe point that I think most doctors are clueless. KSMan needs to open an advisory clinic and charge us monthly to go over our shit…lol…I may have missed it somewhere but I didnt see anywhere that you were given an ai along with your test. 200 test cyp per week is a lit and you may have elevated E as a result.

Have you had your E checked recently? Im new to this as well but feeling worse after starting seems to point in Es direction. keep up the effort man!!


#7

50mg DHEA might be too much. In any case, some freely convert DHEA–>E2 in their adrenals. Labs are needed for E2 and DHEA-S.