T Nation

Begin TRT or Treat Thyroid? Or Both?

37 year old male who’s T has been in the 250-300 range the past 3-4 years. Recent thyroid panel revealed the following:

TSH: 2.65 (.450-4.5)
T3 (Free): 3.8 (2.0-4.4)
T4 (Free): 1.58 (.82-1.77)
Reverse T3: 19.6 (9.2-24.1)
Thyroglobulin Antibody: 17.3 (0.9)
TPO Antibody: 75 (0-34)

I’ve had low appetite, seemingly slow metabolism, some fatigue, crappy libido and low resting HR (48-54) the past couple years, could that be thyroid or low T related? Labs show high antibodies which indicate Hashimotos. Current TRT doc is pushing forward on either clomid or TRT cream, but I keep wondering if I should see an endo and explore the thyroid before doing TRT? Or can I start TRT and address the thyroid after? My GF is growing very tired of the low libido and I’m feeling immense pressure to begin TRT from her. @trifive @KSman

Men struggle on TRT when they are thyroid problems, sure your thyroid is under immune system attack and is classic Hashimoto’s, but seems to be getting the job done, however TRT demands more from your thyroid.

I’m not seeing much of a testosterone hormonal panel, labs are missing and needed before TRT comences. SHBG is needed to form a plan and should be considered before a protocol is chosen. Managed healthcare doctors are typically very poor at TRT, often they do not know how to prescribe it.

If you think you can just inject T once weekly and go, well it may not be that easy. T-creams do not always work. Pre-TRT SHBG and estrogen levels will dictate how you should proceed.

KSman is no longer here, he gave up on T-Nation.

Thanks so much! Here are some more lab values taken at the same time as above. I struggle with anxiety as well, so I’m trying to figure out whether I should start on a low dose T cream or take some form of thyroid meds first? Just basically trying to make sure that my low T levels haven’t been caused by my thyroid, and that if I address my thyroid/Hashi’s maybe it will boost T back up? Or should I just take the T at this point?

Total T: 217 (264-916)
Free T: 8.5 (8.7-25.21)
E2: 19.3 (8.0-35.0)
SHBG: 24.5 (16.5-55.9)
DHEA-S: 423.9 (102.6-416)
Prolactin: 6.3 (4.0-15.2)

You’re welcome.

Total T is low and estrogen not so much and this would dictate at least an EOD protocol because TRT with make you a low SHBG man fairly quickly. Low SHBG men do better on more frequent dosing and those with anxiety even more so because Test cypionate causes spikes in T and E2 which makes trying the T-cream a good idea.

So if the T-cream doesn’t work well, then you would need ED or EOD injections. Your adrenals are a little overactive, cortisol should be tested as well. HCG isn’t recommended if doctor give you this option, HCG can support adrenal function, the last thing you need with an overactive adrenal glands!

I don’t normally see testosterone affected by thyroid or vice versa, but we see men with both suboptimal thyroid and testosterone which is likely do to lifestyle, poor sleep and working night shifts.

Your total testosterone is very low. I would address that, you may do well once your testosterone is optimal and given your levels, it should be the priority. If you have more testing, posting them would help.

No clomid, it’s a short term fix anyway. Is he talking scrotal cream? Injections are 100% absorbed and usually dosed one weekly, scrotal cream 70% and applied twice daily. Gels 30% absorbed. Find out exactly what form of transdermal he is recommending.