44 Y/O - Adrenal and Thyroid Burnout - or What?!

Pharma / TRT Testosterone Replacement
1

Hi,

I’m a 44 year old male, - been a member of this website several years now, - but only posted once before.

Anyway, - I really, really need some advise, since I’m dealing with some issues that are over my head, and I’m feeling completely lost in this pharmaceuitical-endocrino - jungle!

Some background;

I’ve trained my whole life. Primarily martial arts, but also running and lifting weights. The last 10 years my training has consisted of a lot kettlebells, bodyweight and crossfit type training as well.
I dont drink or smoke( only some cannabis, now and then ) and have always had a pretty clean and healthy diet, no soda pops and junkfood. I’ve never done any steroids, but have always used supplements when necessary - herbs, vitamins etc.

In the last ten years I have suffered from joint issues, that have gotten progressively worse, year by year.
This has been accompanied by extreme fatique, which is also getting worse and worse.

It’s so bad that I dont feel like getting out of bed some days. Some days I litteraly feel as if I’m 180 years old, with lead running through my veins!

I have bad mood swings, brain fog, and just a achy, heavy body.
Naturally my training, and my life in general is suffering badly.

I live in Scandinavia, and I have seen tons of doctors here, they have done countless bloodtests, etc. - and nothing has come up.
Except very recently - my doc found that I had borderline low thyroid levels, which he thought could explain some of my symptoms.

So he wanted to start me on T4 only, which I declined, having heard all the horror stories. And since the endo’s in my country are a complete joke, - I instead opted to go to one of the leading endocrinologists in Europe.

They did some blood and urinanalisys and quickly came to the conclusion, that my adrenals weren’t working properly and my thyroid was low.

So… they threw everything, but the kitchensink, at me!

This is the protocol they want me to follow:

Each morning:

Erfa thyroid:
15 mg (quater of a grain) for 10 days
Then 30 mg for 10 days
Then 45 mg for 10 days
Then 60 mg for 10 days
Then 75 mg for ten days

Hydrocortisone:
20 mg followed by 10 mg at lunch

DHEA:
35 mg a day

Pregnenolone:
100 mg a day

Testosterone Liposomal gel 10%:
1 1/2 gram a day on neck and shoulders

Arimidex:
2 X 0.25 mg tabs a week

Furthermore supplements:

Vitamin A:
100.000 iu a day

Vitamin D:
5.000 iu a day

Well, I’m no expert on any of this, but I’ve always been wary of medications, and tried to stay as far away from it as possible. So for me, this protocol seems excessive?

So far I’ve tried the Erfa - up to 30 mg, which made me feel a little drunk and dizzy. So I’ve stopped it again.

Hydrocortisone scares the shit out of me, so I haven’t started that yet.

The preg I tried - gave me a terrible headache, that lasted for two days.

DHEA seems to work a little better, done it on and off now - to try to get a feel for it.

Testosterone - haven’t done it yet.

I’m posting my labwork - and I will be grateful if anyone has any helpful input as I am tatally lost!

  • especially input from KSman is welcomed!!!
2

Need the lab results and lab ranges.

You will take
Arimidex with T, not by itself.

With a thyroid problem, there is a good chance that you will not absorb transdermal testosterone.
Then self injections would be a good option.

If you have adrenal fatigue and elevated rT3, rT3 is blocking fT3. The added T4 in Erfa thyroid will then increase T4–>rT3 and you might not get anywhere.

Please read these:

Please read all of this post and note the last paragraph.
https://forums.t-nation.com/t/advice-for-new-guys/16062412)

  • note the first paragraph
  • we need more info about you
  • this sticky provides concepts and definition you need to understand the ‘language’ of TRT.

https://forums.t-nation.com/t/things-that-damage-your-hormones/1508802

Above is suggested minimum reading.

https://forums.t-nation.com/t/finding-a-trt-doc/1510125

  • the biggest issue in TRT is finding a knowledgeable doctor

https://forums.t-nation.com/t/thyroid-basics/1853443

If adrenals are weak and you take thyroid meds, you may over run the capacity of the adrenals. Happens some times.

Try splitting the thyroid and taking less and observe.

You can monitor oral body temperature.
Should be 97.7 - 97.8F when you wake up, higher would be OK, 97.3F is a problem.
Should get to 98.6F/37C mid-afternoon
Post your body temperatures!

Do you have essential fatty acids and olive oil in your diet?
Getting enough fats?

Vit-D3 is very important in your climate.

Get a men’s high potency B-complex multi-vit with trace elements, including iodine+selenium.

What was your source of iodine? Iodized salt?

Your protocol looks quite good. Vit-A seems excessive. But you hired a company to bring out the big guns.

That is all I can say until I see your labs + ranges.

3

Thanks KSman for your quick reply! You’re knowledge on this whole subject amazes me. Here’s my labwork. I hope that you understand the the measurements, they might be different from the US.
None of the links for related reading are working, I keep getting the message - The page you requested doesn’t exist or is private.

Anyway, - as you can see my rT3 is in the normal range.

I use 2 - 4 drops of a lugols 5%.

I take 400 mg E vitamin, 200mcg selenium, multi vitamin etc.

Use lots of olive, hemp and fishoils.

What is your take on the DHEA and the hydrocortisone?

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4

I have see that private page error before and multiple clicks have produced a result. I will be fixing broken links as I find them.

Vitamin D deficient

Homocysteine indicates that arteries are not healthy.

TSH should be closer to 1.0
fT3 and fT4 are below mid-range
Body temperatures?

Both cortisol and DHEA are low.

Some topical progesterone cream might also improve cortisol.

Rare to see labs this comprehensive. You should go with the suggested meds.

Again, your thyroid condition may block transdermal T.
If that happens and you are taking T+Arimidex, your E2 could easily crash and make you feel unwell.
So that is a difficult problem.

5

I’ve done morning temperature in armpit for 10 minutes, which is the preferred method at the clinic I went to, it’s been a while, so I don’t remember the the data, now, so I’ll try to do the temps again tomorrow.
As for the D vitamin - I’ve had a recent test showing 120, - so I’ve gotten a significant raise from my supplementing.
And my homocysteine levels were back to normal again.

How would self injections with say - 50 mg test cyp. twice a week work, with my thyroid issues - compared to the transdermal?

Would testosterone in and of itself, actually be able to take care of some of the adrenal issues?

Adrenal issues seems to be a very controversial topic these days. Read a lot of articles, claiming it doesn’t even exist, and that other issues is the real cause.

As for the comprehensive testing - yes they are very thorough - but the lab is not where I’ve had my consultations. Unfortunately, the clinic I’ve attended is run by a very famous endocrinologist - and you’re not seeing him - but his assistants, who are definitely not as knowledgeable as him. So they a use a preset pattern, that they pretty much use on the majority of their clients - as far as drug protocols go. Which is why, I am a little skeptical, to start the hydrocortisone.

With that drug, it seems that once you get on - you never get off.

6

what’s the best way to bring cortisol up with progesterone cream? Is it a four times a day protocol - and what dosages would you recommend?

7

Progesterone protocol: You could try morning/evening. Some freely convert progesterone–>cortisol that can interfere with sleep. So applications times sometimes need to adjust for that.

Thyroid is not much of an issue for injected vs transdermal. But TRT will [attempt] to restore metabolic rates and sometimes TRT can feel worse if thyroid and/or adrenal levels will not take you there. Doing one thing at a time may not be the best course of action; but I see that you are wanting to feel your way into each.

8

Would HGH fit into any of this?

I know the clinic is happy to prescribe it…

9

IGF-1 is a bit low relative to optimal.

hGH is very expensive.

When you take hGH, you do not add to your levels, you also replace your existing production.

So if you were producing .7iu per day and started injecting 1.0iu per day, the first 0.7iu has no benefit and you really spend a lot of money to get the net increase of 0.3iu.

So the benefit is really there for those with lower numbers.

It takes about 6 weeks to really feel the changes created with hGH as its a change from the cellular level.

Suggest that you first try to optimize other hormone systems and then see where IGF-1 goes from there. All you need to eval GH status is IGF-1.

10

If I’m low IGF-1 - relative to normal - wouldn’t that be something worth exploring. regardless of the money. Trust me, none of these drugs are cheap here. Dessicated thyroid especially.

11

If you can afford GH, go ahead.

13

I made a lot of changes since the last time, - I’ve consistently supplemented with DHEA ranging from 10mg to 35mg daily.
I’ve started using the sun lamp every day for 10-15 minutes.
I do a ton of different herbs, aminoacids, vitamins and minerals.
I tried starting the Natural dessicated Thyroid earlier in the year - started with Erfa, 30 mg - only half a grain - but unfortunately it made me feel extremely weird. I felt like I was kinda drunk - but not in a good way :slight_smile:
So I stopped it, and felt absolutely shitty for almost two months afterwards, where I think my poor thyroid was trying to get back to work.
At this moment I’m only doing the DHEA as far as hormones are concerned, but my doc wants me to start the NDT again, this time starting out at 15mg, a 1/4 of a grain, for 10 days, then increasing by 50 % every 10 days.
I’m not sure I wanna do this, but after looking at my latest bloodwork I’m really not sure whats going on???

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TSH too high. fT3, fT4 are below midrange.

I can’t see that you have posted oral body temperatures. This is important.

Have you been using iodized salt? - or are you iodine deficient?

Your iron status is poor. Please get an occult blood test. Thus looks for blood cells in you poop from a gastrointestinal bleed. That can be from a food allergy or sensitivity.

I do not see IGF-1/hGH as a factor in any of you lab work.

SHBG is high and your E2 does not seem high enough to be causing that. Perhaps some influence from thyroid problems.

Were you getting selenium in your supplements when thyroid meds made you feel unwell?

I have never seen free cortisol tested and do not know what you result implies. A low level probably means that you active levels are hyper and you may need to have that addresses. What has your doctor said about this?

Thyroid meds made you feel unwell. Perhaps increased thyroid levels outstripped what you body could manage on low free cortisol.

You noted that your rT3 was nicely in normal range, so that is not the problem. So we should not expect that your failed thyroid med event involved T4–>rT3 and we can probably conclude that T3 only meds would not be a useful option.

15

Well, there’s a lot of weird stuff going on, which no one has addressed completely.

I didn’t post body temps,- I did them a while and remember what they were now, but they were pretty low. I will do again and post them.

I have used both iodized salt and 5%lugols 2-3 drops a day on and off.

I’ve been taking around 400 mcg. selenium with Japanese knotweed for almost a year now.

I don’t understand what you mean by not seeing IGF-1/hGH as a factor in any of you lab work??

I’ve been made aware that my transcortine is way out of range - and thats an indication of adrenal burnout? - and others say adrenal burnout is a hoax…

So whats the deal here?