fT3 is the only active hormone, T4 is not active, but is a reservoir for fT4–>fT3.
When fT3 is above midrange and body temps are low, we suspect that rT3 is elevated and blocking some fT3 action making one hypo. And your hands are cold. Your outer eyebrows might also be sparse. Meanwhile almost all doctors will look at your labs and say that things are perfect - most docs do not test or understand rT3.
fT3 is the thyroid feedback signal and as rT3 is interfering, TSH is elevated to compensate.
You need to consider stress factors in your life. See these terms in the thyroid basics sticky.
- TSH, fT3, rT3
- stress, illness, inflammation, chronic, acute
- adrenal fatigue
- Wilson’s book <-- read this
As part of the above, cortisol can be elevated from stress but later cortisol can be low. A number of 10 is well below optimal.
Your history of medications is needed and some can affect prolactin. Prolactin is secreted during sex and when hugging babies, puppies kittens etc. So avoid for net lab work.
When on TRT LH/FSH–[TRT]–>zero, do not test again.
Liver function can affect E2 levels, AST/ALT look fine.