T Nation

Advice Needed

Let’s get right to it.

Age: 53
6 feet tall
33" waist
178 lbs

Chest hair yes, can grow a beard, full head hair. No real fat deposits, on the lean muscular side. Still have six pack.

Symptoms are brain fog, fatigue, lack of motivation, Diminished sex drive. No prior history of illness.

I take LEF Melatonin, fish oil caps, Pro biotics

Diet, no red meat, veggies, salmon four times

A week, chicken, carbs. No calorie restriction.

More cardio than iron for the last few years, 5 days a week.

But nothing crazy.

Never any testes ache. Morning erection has disappeared in last 6 months, still fully functional,
desire is diminishing.

My journey so far: the gradual onset of the above symptoms led me to getting a saliva testosterone test the results of which led me here where I learned.

I had wasted my time and money. Went to the doctor, ordered blood tests which came back with lowish T results. Here the narrative takes a turn from what I have read is the normal experience for people on this forum.

The doctor glanced at my T numbers told me not to worry about any of the others and Wrote scrips for Adex, T, and HCG and shoved me out the door and told me to come back in a couple of months to see how I am doing. He said once week was fine but more frequent was ok too.

Test Results:

DHEAS. 46.4 (44.3-331)
DHT. 23.7 (11.2-95.5)
TT. 405. (280-1100)
SHGB. 47. (10-80)
Free T. 6.03. (1.6-22)
IGF-1. 165. (87-238)
IGFBP. 3.5. (1.6-6.5)
Cortisol. 12.3. AM
Vit. D. 32. (>30)
LH. 2.9. (1.7-8.6)
Progesterone .23. (.2-1.4)
E1. 4. (<60)
Estradiol. 9.9. (7.6-42.6)
Hemoglobin 5.2 (<6)
Ferritin. 133.1. (30-400)
Triglycerides. 66.
Cholesterol. 130
HDL. 58
LDL. 59
TSH 5.15. (.27-4.2)
Free T3. 3.1 (1.8-4.6
Free T4. 1.39 (.27-4.2)
PSA 1.03. (0-4)
FSH. 4.7. (1.5-12.4)
Blood panel and general chemistry were all center mass in ranges.

Day time temperatures have been running 98.4 but have been taken with a digital thermometer. Mercury one is on order as is an Iodine test. I have been eating with sea salt so suspect some iodine deficiency. Threw out the sea salt and changed to iodized.

Questioning the need for Adex with an E2 of 9.9 (7.6-42.6)
Low vitamin D number so I have started a supplement.
Low DHEAS so I have started LEF supplement.

Doc said TSH number was nothing to be concerned about.
Same for Ferratin number and low LH.
Have not tested for Hashimotos, or RT3.

Ideas, comments or opinions would be welcome.

Doc is an idiot, your TSH is hypothyroid level. T3 over range, where is T4? i suggest you find a thyroid expert get a full panel with antibodies and get a thyroid ultrasound. Don’t start TRT your T is lowish, but could correct itself once you address the other issues. Cortisol is lowish, what time AM was it taken?

Good on you to get supplements for dhea etc. You need cholesterol to create steroid hormones, a little higher wouldn’t hurt some egg omelet breakfasts here and there :smiley:

I’d throw in a coenzyme b complex + a full spectrum mineral supplement, but that’s just opinion.

Your IGF1 is on the low side which means your probable GH deficient, but that’s something very expensive and hard to get.

The adex is in case your E2 goes over the optimal (15-28) 22 is supposed to be the sweet spot. When you inject T some of it aromitazes to E2. You being lean means you should aromatize less than a person with more fat.

T4 Free 1.39. (.9-1.7)

Entry error on T3 and T4. Original post is edited. Sorry for the mistake. T3 and T4 are in range and doc was unconcerned about the
TSH number.

Six months ago cholesterol was 112 so the 130 number reflects a few more eggs added to my diet.

Cortisol was 9am.

TSH number is a big concern, again get another opinion and find a better doctor. No reasonable doctor should dismiss you like that with that TSH.

What’s your iodine intake?

Do you cook with iodized salt? Do you eat a lot of soy products?

I’m not trying to scare you, but my mom had a similar TSH to you and a few doctors said the same thing they said to you. I found her a thyroid expert who ran a full thyroid panel + ultrasound he found goiter, hypothyroidism, nodles, and, cysts. get a doctor who will evaluate and guide you properly.

No soy product intake. And until recently was seasoning with sea salt so iodine intake is suspect. I have ordered A ZRT labs iodine test kit to check levels.

You have done a great job. I am highly suspicious of iodine deficiency. You may need 12.5mg Iodoral.

High TSH can enlarge the thyroid gland, from there the over stimulation can lead to asymmetries and nodules. The nodules can be TSH independent, releasing thyroid hormones, then as things progress, TSH goes low and you have hypothyroidism and risk of cancer.

Your TSH is driving the thyroid hard, to presumably overcome an iodine deficiency. This is yielding good numbers, so your doc things things are fine. From one narrow point of view, he is correct. If iodine replenishment does not fix QOL, T or TSH, the cost has been marginal, and there are other roles for iodine in the body that will benefit.

Did you do anything in the 1-2 years past time frame that would reduce iodine in your diet. How long without red meat.

How long without red meat. I want to call a B-12 deficiency. You should be using a high potency B-complex multi-vit with 150-180 mcg iodine. But note that that amount of iodine will not be able to provide any iodine replenishment.

You may need adex when on TRT.

Your cholesterol is deeply way to low. Eat red meat, animal fat, eggs. If you read LEF you will see statements that ‘’'cholesterol levels less that or equal to 160 are associated with increased all-cause mortality""". Low cholesterol undermines all of your steroid hormone production, including Vit-D3. Cholesterol is very important in the body, and not evil.

Vit-D3: What is your exposure to sun light? Not that darker skin reduces one’s vit-D response to sunlight. Vit-D25 is a steroid hormone. Vit-D3 is based on cholesterol.

study this: http://en.wikipedia.org/wiki/Steroid_hormone

You are luck to have that doctor, this gives you room to do things right, VS not been able to do anything.

Recommendations:
-increase animal fats to increase cholesterol

  • b-complex as described above
  • iodine replentishment

You might hold off on TRT and try to fix things. But at 53, you are getting into age driven decline and the head room for recovery is reduced.

Low T and thyroid problems have many symptoms in common, and with both, one could expect the symptoms to be twice as deep.

KSman-
In the last two years I shifted to sea salt and then a few months ago back to iodized.

The no red meat has been a life long thing, no ethical basis I just don’t care for it and
have always gotten my protein from fish or bird sources.

Funny you should mention the LEF statements regarding low cholestorol. After reading them I told my doctor I was concerned about my chronically low cholesterol numbers and his response was “You are going to die from cancer or heart disease, pick one” implying that raising my cholesterol numbers would lead to higher risk for heart disease.

My sun exposure is non existent in the winter unless I am on vacation. I live in northern Alaska so no chance of winter sun. I do use a Verilux Happy Light every day.

Moving forward I have started the following:
DHEA supplements
Just ending Vitamin D loading and will continue with 10,000iu per day.
Vitamin B complex
Eating red meat every day.
Have ordered some Iodoral.

I have doctors appointment on Thursday where I hope to get a test for Hashimotos and Reverse t3 to help further define the thyroid problem. I hope the doc will be willing to discuss treatment of sub clinical
hypothyroidism. Seems to be a wall I am running into.

What have peoples experience been regarding TSH levels while using Iodoral? The literature seems to indicate that iodine supplementation causes TSH to go up. Is this a transitory problem that reverses itself as iodine gets replenished?

I have filled the prescriptions for Arimdex, HCG and Testorone but am debating now whether to start TRT as it might be better to mess with one variable at a time, i.e. my thyroid issues, before dealing with the low T.
Not sure. Anyone out there ever deal with simultaneous thyroid and low T?

Sitting on the fence staring at a syringe.

For your age, loss of T and DHEA levels are expected. So you make need TRT in the next few years in any case. You seem to have a good doctor to work with.

Free T4. 1.39 (.27-4.2) - mid range is 2.235, you are only 62% of that midrange. It will be interesting to see what the iodoral does.

Was just diagnosed with Thyroid Cancer. Showed up on an ultrasound. Biopsy yesterday.
The take away here is to be aggressive with your doctors about what you want and only stop when you have a definitive answer. Two doctors told me based on labs there was nothing wrong with me. Thanks to everyone here that taught me to take ownership of my health care and be wary of doctors conclusions.

Not all thyroid nodules are cancerous. Do you actually have the pathology completed? I watched my sister in-law have the needle biopsy done [no cancer]. She never used salt after cooking for her grandmother who was on a no-salt diet. She then continued with those meal prep habits. She ended up with an enlarged thyroid, asymmetrical and lumpy. Did docs detect that, during regular checkups? NO. Only came up after she was in the emergency ward twice with thyroid storms. The nodules became TSH independent T4/T3 secreters and her TSH is now zero. So she is now technically hypo and managing in that state. That is what iodine deficiency can do.

Yes, the pathology is completed. Appointment with a surgeon on Tuesday to discuss options. The biopsy was less of an issue than I thought it would be, hurts a little now but would compare the experience to going to the dentist.
I know this is not a Thyroid Cancer board, but I just wanted to stress that had I not lurked here and read about others experiences with the health care system I would not have found this cancer in the time frame I did. For that I am very grateful to this board. Hoping to successfully deal with the cancer and then return here to address the testosterone issue.

[quote]Auboy wrote:
Yes, the pathology is completed. Appointment with a surgeon on Tuesday to discuss options. The biopsy was less of an issue than I thought it would be, hurts a little now but would compare the experience to going to the dentist.
I know this is not a Thyroid Cancer board, but I just wanted to stress that had I not lurked here and read about others experiences with the health care system I would not have found this cancer in the time frame I did. For that I am very grateful to this board. Hoping to successfully deal with the cancer and then return here to address the testosterone issue.[/quote]

I know this is a challenging time for you, but stay strong. Thyroid cancer caught in time is a very treatable cancer. If its okay with you, can you post the biopsy report and your thyroglobulin levels? if you haven’t had thyroglobulin done you need it. Were the cysts calcified? Research before committing to surgery, don’t go to any surgeon, find the best. Where are you located?

In general to others reading, if you have thyroid issues demand an ultrasound, thyroglobulin, and full thyroid panel + antibodies, never settle with docs and their normal talk.

Do not take any iodine supplements now. If use radioactive iodine to study the nodules or to zap the thyroid, the absorption will be limited. They would tell you to avoid such and such and to avoid bread. But iodine has not been used in bread for decades…

Surgery is not used often now. There are lots of blood vessels and nerve. But if there is/are easily removable bits and the remaining gland is viable, that would be nice. Otherwise radioactive iodine is used and the thyroid absorbs it and dies off. The later option has much less surgical risk.

I am really sorry that you are faced with this problem.

Getting the biopsy report on Monday.
I live in Northern Alaska and am heading to Seattle to be treated. My doc told me to get out of town for treatment as local talent can be inconsistent. I have an appt. with a well recommended surgeon at a cancer center on Tuesday. Just hope the holidays do not get in the way with surgery availability.
Have not had a Thyroglobulin test, why would this be helpful?
The current plan is to completely remove the thyroid and then kill the rest with radioactive iodine.

Trying to stay upbeat and optimistic.

Apologies to all for hijacking a TRT forum with Thyroid issues, but this forum and advice may have literally saved my life. I went through two doctors before getting one that would listen and do as I asked and provide the testing I wanted. The experiences posted on this forum gave me the tools to dictate my healthcare as I wanted it and for that I am very grateful to everyone who has shared their experiences and knowledge.

Good Fortune!

[quote]Auboy wrote:
Getting the biopsy report on Monday.
I live in Northern Alaska and am heading to Seattle to be treated. My doc told me to get out of town for treatment as local talent can be inconsistent. I have an appt. with a well recommended surgeon at a cancer center on Tuesday. Just hope the holidays do not get in the way with surgery availability.
Have not had a Thyroglobulin test, why would this be helpful?
The current plan is to completely remove the thyroid and then kill the rest with radioactive iodine.

Trying to stay upbeat and optimistic.

Apologies to all for hijacking a TRT forum with Thyroid issues, but this forum and advice may have literally saved my life. I went through two doctors before getting one that would listen and do as I asked and provide the testing I wanted. The experiences posted on this forum gave me the tools to dictate my healthcare as I wanted it and for that I am very grateful to everyone who has shared their experiences and knowledge.[/quote]

I shared my story with you a few posts back. After I researched I took her to a doctor who has been working specially with thyroid patients and operating on them since 1946. After the ultrasound the biopsy suggested removal of the thyroid. The doctor said pathologist are notorious for being knife happy. In some cases using synthroid can shrink the thyroid and abnormalities. He ordered thyroglobulin serum www.ncbi.nlm.nih.gov/pubmed/10418587 which is a good indicator if there is indeed thyroid cancer and removal is necessary, came back negative. If you were in California I’d suggest you drop by with this guy. You need thyroglobulin AB as well.

If you do get the removal I recommend you buy the book “stop the thyroid madness” and learn about T3,T4, and dose adjustment. You will need thyroid replacement, for that armour is better than T3 only meds.