Another Low T Guy

Pharma / TRT Testosterone Replacement
1

Age - 40
Ht - 5’11"
Wt - 190lb
-describe body and facial hair
facial hair normal. Normalish chest and stomach hair. Very little back hair.
-describe where you carry fat and how changed
Midsection and the glutes. A little bit of fat under the nipple, towards the armpit.
-health conditions, symptoms [history]
None
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Currently using Minoxidil 5%. I used Propecia for about 3-6 months about 10 years. Did not like the sides so quit it.
-lab results with ranges

Sodium - 139 mmol/L
Potassium - 4.3 mmol/L
Chloride - 103 mmol/L
Carbon Dioxide - 27 mmol/L
Calcium - 10.0 mg/dl
C-Reactive Protein, Quant <4.0 mg/L
E2 - 9.11 pg/mL
Triiodothoryonine, Free, Serum - 3.02 pg/mL
Free T4 - 0.94 ng/dL
Prolactin - 4.50 ng/mL
Sedimenation Rate - 5 mm/hr
Testosterone, Serum - 160 ng/dL
TSH, 0.98 uIU/mL
Vitamin B12 - 822 pg/mL
Bunch of other stuff that was in range

-describe diet
Overall good quality. In a caloric surplus now to gain muscle mass.
-describe training [some ruin there hormones by over training]
Doing starting strength program for about 4 months. 3X/week barbell training (big compound movements). Recently, I burned out am taking it easy. I suspect overtraining has negatively affected my testosterone.
-testes ache, ever, with a fever?
No problems
-how have morning wood and nocturnal erections changed
Not much wood in the morning. Sometimes nocturnal erections, but rarely.

General Issues

Fatigue, brain fog, sleeping a lot, lack of productivity, mild depression at times but seem to be able to fight it off.

Temperature

Temp has been on the low side during the day for last few days (96.5-97.5F), but I have not monitored it right after I wake up. I will start monitoring it more. I plan to take some iodine supplements.

Notes

I had a another test 2.5 years ago and the testosterone, serum was 475ng/dL, which was decent. I not sure what has happened since then. Maybe my body was hit hard with the weight training?

2

Been reading and I think understand reasonably well what to discuss with the doc. Thanks for the all the help guys. A few questions:

  • My E2 is 9.11 and quite low. Does this mean I can skip the AI, at least for a while? My concern is that the doc won’t play ball if I ask for too much right out of the gate. He didn’t even mention TRT and I’m at 160! That is a terrible level, though I am still concerned it was due to a hardish workout before getting tested (and possible overtraining). But that still doesn’t address the fatigue I have had for years now.

  • Can I skip the hCG for the time being and just going? I am just looking to feel better in the short term. If TRT turns out to be the answer, I can then add in the hCG for the long term.

  • My thought is to just try to get some test that I can self inject and be happy with that immediate solution. The doc may buy that. Then, if I am noticing the desired improvements, we can go to the lab work to see if AI is needed. At that point, it would be an easier sell to the doc. I am just wanting this darn fatigue to go away.

3

You should have LH/FSH tested to see if your testes or pituitary are the cause. Can’t do that later!

Your labs do not show ranges.

TSH looks good, but fT3, fT4 seem low. Please read the thyroid basics sticky, check waking and mid-afternoon body temperatures. Eval your long term use of iodized salt and/or vitamins that list iodine.

E2=9.11 is consistent with your low T.

Please read the advice for new guys sticky to understand basics and definitions.

We often see guys with thyroid issues who cannot absorb transdermal T. Doc might push that and will not understand.

Please post your prior thyroid labs. More that TST, fT3, fT4? How hyper were you and what were the meds?

4

Thanks fellow ME

  • I am going in for more blood work in a couple days. First on my list was LH/FSH. I also and going to request iodine and cortisol test (and anything related to adrenals).

  • Sorry about ranges. I will add that next time.

  • I have been monitoring body temp and it is low. Upon waking, it is usually about 96.5-97.0. Today was 96.6. During the day, it can get as high as 97.8, but have not reached 98.0. I have not used iodized salt for many years and have not been taking multi vitamins until recently. I plan on starting IR today with Lugol.

  • I am not going use transdermal no matter what. If I go on TRT, I will do injections. I have located an anti-aging clinic that will do additional blood work and give me everything I need for self injection. I want to try to work with the GP first, but I have a back up plan.

  • As far as prior labs, I don’t have much. TSH 3, 1.24 uIU/mL, 0.55-4.78. I was never hyper or had any meds related to that.

  • How much of this could be mental/stress related. I don’t have too much stress overall, but sometimes I stress pretty hard for short periods.

5

Adrenals:
DHEA-S

When thyroid is a mess, TRT can make you crash because of your reduced metabolic rate. You should focus on thyroid first.

The issue with adrenals is adrenal fatigue which can raise rT3 which can block even good fT3 levels from getting fT3 inside the cells. See the stickies.

Stress:
Can be from medical issues, starvation diets, accidents, surgeries, situational, over-training …
I sometimes think that iodine deficiencies could be a causative stress.

6

  • Since my labs came back normal for thyroid, my doc may not be willing to do much for that. I specifically told him about low body temp last time and he shrugged it off. I will try to be more persuading.

  • Should I request rT3 because of low body temp and possible adrenal fatigue? I would think so. Either way, I will keep monitoring temp and adding supplementation. If body temp becomes normal, can I assume my thyroid is OK since the current test data isn’t too bad?

  • I agree that I should get my body temp in order before I do TRT. Who knows, that may resolve my low T and other symptoms even? Is it too early to retest or should I wait for the IR to kick in?

  • I have Wilson’s book on order. I want to cover all my bases on this. I have to get feeling better ASAP for work related schedules.

  • Diet is good. I eat healthy, but have some cheat days and sufficient protein/carbs/fat. I have gained a lot of weight recently (20 lbs in a few months during weight training). A decent amount of that is fat (about 50%). I heard that fat can cause low T. My body is used to being skinny, but am I sort of averagish now. A bit of pudge in the belly.

Thanks again for the help. I feel encouraged that my symptoms can be significantly improved.

7

Some additional info my doctor had. It was only on his screen and for some reason I did not get it. I did not see the ranges, but have the values.

Free testosterone, 5.3
DHEA, 221

My doctor suspects my low T is related to cortisol/DHEA. I had some additional lab work done and will get rT3 and LH/FSH.

He did not have the adrenal saliva test, but was aware of it and wants me to do it. The I plan on getting is on Amazon:

ZRT - 4 cortisol hormone saliva tests to be done over 24 hours plus DHEA-S test.

P.S. My doctor is familiar with everything discussed on this forum regarding TRT, which is surprising compared to other reports. He also suggested I go to a “special vitamin store” and talk to a guy there. I wasn’t expecting much, but the first thing he asked me about temperature and was ready to give me iodine. I told him I was already on it and the dosage he suggested was the same as the sticky. He gave some pills to help the adrenals, which are consistent with what is in Dr. Wilson’s book. Point is, some doctors know what is going on so that is great!

8

I started IR 7 days ago and have taken 250mg so far.

Also taking Vitamin C, Ashwaghanda, and an Adrenal Complex to help with potential adrenal fatigue. I have very little apparent stress other the stress of trying to figure out why I am so fatigued and have general low T symptoms.

Temperatures remain at 96.6-96.9 in the morning to about 97.5 averaged throughout the day. Temperatures went up a bit on day 4, but now they are back to the same as day 1. Is it too early to expect anything? I would have thought there would be some improvement by now?

9

You are not showing much progress from the iodine at day 7 and 250mg.

What was your intake of iodized salt? If none, for how long were you not using iodized salt. I am trying to get a sense of your iodine deficiency’s depth and width[duration].

Are you getting selenium in your vitamins? That is very important for thyroid function and a deficiency can lead to thyroid auto-immune disease.

Also need to know LH/FSH to determine what we are dealing with.

Have you checked that someone else can hit 98.6 with that thermometer?

10

Thanks for replying KSman :slight_smile:

  • Previous intake of iodized salt at home was zero for at least 20 years. However, I do eat out a lot. I never add any salt though.

  • I just ordered Selenium the other day and will start supplementing immediately. I have never supplemented with it before.

  • I have not checked the thermometer with anyone else. I got to 98.3 one time though. I am using a digital thermometer, but I compared it with a Geratherm glass thermometer. They both read the same. I can get readings from both thermometers from now on. I also take ear thermometer temps as reference. They are pretty close, but I rely on the oral temps.

  • Just got new labs. I don’t have all the data, but most came in. Waiting on updated testosterone and rT3.

E2, 6.52 pg/mL, 7.63-42.60, LOW
Triiodothyronine, Free, Serum, 2.68 pg/mL, 1.90-3.50
Free T4, 0.84 ng/dL, 0.58-1.64
FSH, 7.04 mIU/mL, 1.27-19.26
LH, 3.52 mIU/mL, 1.24-8.62
Vitamin B12, 1023 pg/mL, 180-914, HIGH
25-OH Vit D, 27.6 ng/ml, 30-100, LOW

A bit surprised Vit D is low. I have been taking 5,000 IU twice a week for about 6 weeks.

11

Some are hyper vit-D3 metabolizes. You can try to saturate your stores by taking a lot. I have seen 300,000iu in some clinical studies.

Prepared foods and restaurants typically do not use iodized salt. Its up to you at home. You must take iodine supplements if you do not salt your food. Others in your household may have similar issues as you.

You have long term iodine deficiency, so may take longer to recover.

You can get selenium as part of a good multi-vit.

fT3 is mid range, but range seems low. Typically we are looking at fT3 mid range of 3.2-3.3

fT4 is low, consistent with iodine deficiency

E2 is consistent with low T and is certainly not the cause of low T.

FSH is rather high, LH may be caught at a trough. This with your low T suggests primary hypogonadism. We typically do not expect that to be an outcome of hypothyroidism as that pattern is well established for secondary hypogonadism. But perhaps the testes are not working well because of a direct effect of thyroid problems. So this is not fully resolved. Have your testes been physically examined looking for vascular abnormalities? Note that some testicular cancers can increase FSH. So the exam can look for two things. But note that testicular cancers seem to be mostly a young man’s disease.

12

  • I will just stay on iodine and get to 750mg. At that point, I will ramp down, but get to 1000mg a few weeks after reaching 750mg. Then go on a maintenance dose. I would think that should cover any iodine deficiency?

  • Regarding the recent labs, my doctor said “nothing concerning for any brain abnormality in signaling the glands”. I guess this means he believes it would not be secondary hypogonadism. But primary hypogonadism is a possible/probable outcome.

  • I just realized my multi-vitamin is 3 pills/serving, not the 1 that I have been taking. And I have not been taking it regularly. I only started taking multi vitamins within the last couple months so perhaps there is a Selenium deficiency. I will take Selenium at 300% of RDA for a while. Unless a higher level would be beneficial?

  • Testes have not been examined. I did a self test and could not feel any lumps or bumps. Everything seems to look and feel normal.

  • So do you think that hypogonadism is probably a root problem (in addition to ID)? In other words, is TRT likely in the near future? My doctor wants me to wait 3-6 months and try to address adrenal fatigue and other factors naturally. But I feel like crap and would really like to do something more immediate about it. Of course, I don’t want to be premature either. If I can naturally resolve this via IR and adrenal health, that would be great. But I have a gut feeling that isn’t going to cut it. Thinking back, I have had a lot of these symptoms for a while, but I just sort of ignored/dealt with it. During a lot of those times I was perfectly fine and stress free. I could see ID being a problem, but not so sure about adrenal fatigue.

13

Another blood work update:

Reverse T3, Serum, 13.8 ng/dL (9.2 - 24.1)
Testosterone, Serum (Total), 293 ng/dL (no range indicated)
% Free Testosterone (Dialysis), 2.0% (no range indicated)
Free Testosterone, Serum, 59 pg/mL, (no range indicated)

So this is an improvement from the previous low total testosterone value of 160. I suspect it may have had to do with overtraining or because I worked out the day of the test? I heard T levels can drop when you work out too close to the time of test. Is my risk of overtraining very high if T levels are low? Should I start working out again, at the risk my T levels plummet again? I had stopped working out for about 5 days before the last test. This is confusing.

14

KSMan, sorry to disrupt the Thyroid Basics thread. FYI, that was an attempt (for myself and others) to understand if a higher dose would be recommended, provided long term iodine deficiency is identified (as opposed to a more general 750mg). I don’t know the number, but it would seem one could ramp up quickly to 750mg and then slowly (~3-10mg/day) to get to about 1250mg. In that case, it would seem you are covered, but not overdoing it. This is just a guess though.

In any case, here is a summary of relevant old and new results:

10-4-2014

Testosterone, Serum, 160 ng/dL, (348-1197)
Free Testosterone(Direct), 5.3pg/mL, (8.7-25.1)
E2, 9.11 pg/mL, (7.63-42.60)

TSH, 0.98 uIU/mL, (0.34-5.60)
Triiodothoryonine, Free, Serum - 3.02 pg/mL, (1.90-3.50)
Free T4 - 0.94 ng/dL, (0.58-1.64)

Dehydroepiandrosterone (DHEA), 221, (8.7-25.1)

10-11-14

Testosterone, Serum (Total), 293 ng/dL, (348-1197)
% Free Testosterone (Dialysis), 2.0%, (no range indicated)
Free Testosterone, Serum, 59 pg/mL, (no range indicated)
FSH, 7.04 mIU/mL, (1.27-19.26)
LH, 3.52 mIU/mL, (1.24-8.62)
E2, 6.52 pg/mL, (7.63-42.60) , LOW

Triiodothyronine, Free, Serum, 2.68 pg/mL, (1.90-3.50)
Free T4, 0.84 ng/dL, (0.58-1.64)
Reverse T3, Serum, 13.8 ng/dL (9.2 - 24.1)

Vitamin B12, 1023 pg/mL, (180-914), HIGH
25-OH Vit D, 27.6 ng/ml, (30-100), LOW

General

-Temperatures have not significantly improved since IR. Currently at 625mg. Waking temp about 97.0. Peak daytime temp about 98.0. Thermometer compared to diff manufacturer and found to be identical.
-Took Vitamin D 10,000IU/day for days and now at 5,000IU/day. Vitamin K2 added for syngestic effect.
-Taking 4 sample cortisol test as well as total testosterone within the next couple days (mail in kits)
-Plan is to take all thyroid and testosterone/estrogen tests in 2-3 weeks. This should allow for IR and other supplements to kick in and get a new baseline.

15

If IR does not resolve your body temperatures, then it would be good if you could do a trial of some thyroid meds to see how temperatures respond and how you feel. The increase in vitality etc from the thyroid meds would be a measure of how much of what you feel is from a thyroid issue; which has diagnostic value.

It appears that rT3 is not a major factor here.

I am starting to suspect a thyroid issue that is beyond ID.

FSH is typically a better indicator or LH status than LH itself. The numbers suggest primary hypogonadism. As far as I know, thyroid problems to not cause primary and fixing thyroid status does not resolve. You may need to be on TRT. Note that TRT on top of a thyroid problem can make some feel worse.

Cortisol will fill in the blanks.

What kind of ME work/field have you been into? Any exposure to chemical fumes etc?

Is your doc going to throw up his hands with multiple issues and send you to an endo to get rid of you?

16

  • I had hope IR would restore body temps to normal. Things were looking positive, but the readings from the last couple days show no improvement since the start.

  • No significant exposure to chemicals from work. Mostly just computer work with minimal time in the manufacturing area (aerospace). Probably more exposure than I would like as a kid. Lots of pain thinners, contact cement, that sort of thing due to a business run out of the home. In general, I am sensitive to chemicals. Side note, I tend to get nauseous in elevators and anything that accelerates/jerks the body. More sensitive than vast majority of people.

  • I am working from home on my own schedule. This means I sleep when I want and my sleep schedule is erratic. Will this affect the Cortisol tests? Doc initially thought it may be related to cortisol, but too early to tell.

  • What measurements indicate hypothyroid, aside from body temp? In other words, what should I say to the doc to convince him to try it out? What is the the drug and dose?

  • Doc has been great so far. He is fine with self injecting TRT protocol (if/when it comes to that) and is familiar with adrenal fatigue. We have not discussed thyroid since nothing is clinically out of bounds. He is pretty open about things though.

17

You can do a thyroid med trial to see if you feel better AND temperatures increase. If so, then you know that your issues involve thyroid function. See paragraph 1 in my prior post.

Suggest dessicated thyroid product. If doc says that there would be an insurance issue with the Rx because there is not clear lab diagnostics to support that, explain that you are willing to pay for the Rx trial out-of-pocket.

Based on the following and your symptoms, I think that Rx is justified.

  • Sometimes TSH does not tell the whole story.

Triiodothyronine, Free, Serum, 2.68 pg/mL, (1.90-3.50)

  • should be near 3.2-3.3

Free T4, 0.84 ng/dL, (0.58-1.64)

  • should be near 1.2
18

  • Body temps are still low, but I have been feeling better. This may be due to IR, increased Vit D, or adrenal supplements though.

  • My doctor has agreed to a 6 week low dose trial with Armour. Do you know what the proper dose might be, just to compare it? I am awaiting the prescription.

  • Is thyroid something that has a feedback like testosterone? Will my body produce less thyroid when on medication? The reason I ask is that I have not had any thyroid blood work done since before I started IR. I don’t want to be premature if levels have naturally improved. Now that I have completed IR, should I redo the thyroid blood tests? ZRT has a blood test kit on Amazon. Would that work? I will probably do it myself since I don’t want to push the doc too hard with requests.

19

FYI, here is the dose. Armour 15mg, 1 tablet twice per day.

20

Yes there is a feedback system for thyroid hormones.

Lab status since IR? Depends on how patient you are.