T Nation

Blood Work/Symptoms, Not Sure What To Do

My Free T3 (Tryiiodothyronine, Free, Serum): 3.7pg/mL [2.3-5.0]

I just got some blood work to see where I was at and have a baseline for the future. In all honesty I have been feeling a little under the weather lately but I thought It was mostly stress from school and what not. The results from the blood work kinda shocked me and I’m not sure what I should do about it.

-age: 19
-height: 5’9
-waist: 32-33 inches
-weight: 200 - 205

In my honest opinion I have a muscular build for my size. I do carry some noticeable abdominal fat but its not a lot. I eat quite a bit.

-describe body and facial hair: Very hairy from the waist down and lower back. Hairy arms with a decent amount of hair on my abdominal area (happy trail). Some chest hair and some hair on my back and shoulders (minimal). Can’t grow a full beard yet but I have the ability to produce a nice neck beard w/sideburns and mustache. Bushy eyebrows.

-describe where you carry fat and how changed: I don’t know if my fat storage areas have ever changed really. They are usually lower abdominal, love handles, a bit in the chest and pubic area. I was pretty obese up until about 16-17.

-health conditions, symptoms [history]: Like I said, I was fat mf’er for most of my life with very little physical activity (made it up to about 290 and then dropped to 150ish) but I lost all the weight, put on some mass, and now look pretty decent IMO. A few years ago I was hospitalized for appendicitis after the docs f’ed up the surgery and I was there for about a month. Current symptoms include some dry skin that is the worst on my face. I feel like the quality of my skin has been declining over the last few years. I get weird heart sensations (I think its my heart) while eating after training that feel similar to adrenaline rushes. I also feel like I’m fatter than I should be but so does everyone else so I’m not sure about this one.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: I have been on antibiotics after my appendix bs. Oh and some pain killers post surgery (mmmmm, morphine…). I was on advair for some asthma the doctor thought I had when I was a kid (around 8 or so).

Supplementation: Opti Men Multi, Vit C 2g a day, Flameout, 10kiu of vit D daily, ZMA, whey, creatine, leucine. I also used iodized salt.

-describe diet [some create substantial damage with starvation diets]: As stated previously, I was a mini Jabba the Hutt from around 12-16 or so. I would eat a lot of whatever I wanted ALL THE DAMN TIME. In high school I picked up weight training and became not so fat. I managed to get down to about 150ish doing cardio and what I thought was lifting. Oh, I also ate like a bird. Later in HS I decided I wanted to be absolutely shredded so I dieted again this time in a smarter fashion (still pretty stupid though) to the point where I was kinda in a shitty mood all the time (I hear this is expected anyways). Other symptoms from this harsh bs included dry skin (the skin around my nails was cracking), brittle nails, and weak erections. But I did have some sick abs for about 2 weeks!

-describe training [some ruin there hormones by over training]: Been training around 2.5 years. At first I did random exercises because I had no idea what I was doing (definitely never overtrained). More recently (about a year now) I have been powerlifting competitively and have put on a significant amount of mass (fat too). My current lifts are a 435 squat, 295 bench, and a 525 deadlift @198 RAW (dead has gone down a bit since I tweaked my back but its coming back up). I train heavy 3-4 times a week.

-testes ache, ever, with a fever?: I do remember this one time a few years ago where my nuts started hurting for like 30mins and then it went away. Only once though.

-how have morning wood and nocturnal erections changed: I get good morning wood probably once a week. I do sometimes wake up with a wicked boner (it actually hurts) mid-sleep sometimes but this is somewhat rare. Most of the time I wake up and Jr is only standing at half mast or nothing. I know I’ve had morning wood throughout my life but I don’t think its ever been very consistent. I can get a woody pretty much on command. It stays hard but I think I have to give it some effort at times (this may be mental).


Note: I’m not clueless when it comes to hormones but I’m definitely not well educated on this. The pdf wont let me copy text so I’m gonna try and figure out a way to get this posted.

Rest of the labs

Most of your bloodwork looks pretty good…Test is on the low side for your age, but so is your LH/FSH so you seem to be producing what your body is telling you to…this is good in the sense that your nuts are probably ok (not primary) but bad in the sense of you dont know why your body isnt telling you to make more T.

Estradiol looks pretty good…could be beneficial to lower it though not with the heavy stuff (AI’s)…think natural supplements–resveratrol comes to mind but there are others.

Always take fish oil and Vitamin D (6k iu/day).

Your liver values are slightly elevated, but these are expected in a heavy weight training male. No need for alarm there, but if you REALLY want to put your mind at ease take a week off from the gym and retest the liver markers…they should fall into range.

But that takes us to TSH, FT4, and FT3, none of which are great.

My theory: you have suffered a degree of hypoadrenia. What with your anorexic dieting in the past, major surgery and recovery, and constant heavy training (I did not say the latter was a bad thing).

Your FT4 is above range, which should mean you have plenty of the active hormone, T3, for your body to use…but you don’t, as T3 is in the middle of the range (you want it in the higher end). This also indicates a high probability of Reverse T3 pooling, which blocks your actual T3 from doing its job. This seems to be confirmed by your highish TSH.

I know it sucks, but my suggestion is to spring for 8 am cortisol and Reverse T3 levels. If you can swing the 4x saliva cortisol test, that would be even better as it will show your results throughout the day.

Treatment can include Isocort to improve cortisol, or if you have a doctor to work with a possibility of Cortef HC and T3 meds.

Thank you very much for the response VT.

I’m glad to hear that the rest of my blood work looks good. I did freak out a bit when I saw the results but I realize that this is very counter-productive. I need to do what I can to better myself.

  • I really am not concerned with the liver values and realize they are what they are because of lifting.

  • I will continue to do the fish oil and 6-8iu of Vit D a day.

I have several questions…

  1. Is it possible that my body is still recovering from the retarded dieting and surgery from previous years? The most recent dieting stunt was a little over a year ago. I now am much more educated about nutrition and will never mess myself up like this again. Is it possible that it will simply take time for my body to start producing more LH/FSH? If not, is there anything I can do to kickstart this? I realize my test is not super low but I definitely do not think it is acceptable in its current state. Should I look to natty T boosters?

  2. I know T levels fluctuate. Is it possible that my test is simply lower at this point in time? Maybe I’m overtrained and don’t realize it?

  3. Now as far as Thyroid/Cortisol treatment is there anything I can do naturally to try and remedy this (iodine, kelp, etc.)? Also, do my thyroid problems classify me as hypo or hyperthyroid or is it just messed up in some other fashion?

I am under the impression that thyroid meds are something you have to be on for life. Please correct me if I’m wrong. I will definitely look in to having those tests done. It’s just hard at the moment because money is tight (broke college student).

  1. Would it be stupid to try Isocort without testing first (I’m guessing the answer is yes)?

  2. How closely linked are these two issues (T and Thyroid)? WIll fixing my thyroid increase my T?

I have a doctor that seems to be a pretty nice and knowledgeable guy. With this said, I have no idea what he does or doesn’t know about any of this. I do have a physical coming up this month and will show him the blood work. I’m not too sure how to go about asking him for help though. I’m not someone who wants to jump in to taking drugs before knowing that its necessary. I am however willing to do what it takes to improve my situation. TRT at my age doesn’t sound right to me and I’m sure most of you will agree.

Any input is greatly appreciated.

I really think your lower-than-ideal T is a result of possible hypothyroid/cortisol problems, and fixing them will cause a corresponding increase in T…your focus shouldn’t be on the T at this point, even if you increase it you may not have enough cortisol/thyroid hormones to support it and your body will crash due to the extra demands being placed on it…

The RT3 and Cortisol tests are imperative to identify proper treatment…

The thing is that regardless you are probably going to have to look into self treating–most doctors are well behind the curve when it comes to these sort of issues.

Understand that money is tight, but I don’t know what to tell you other than that…

Are you not covered by your parents insurance as a college student? Any chance of reduced insurance plan for students?

I am covered by my parents insurance but they (the insurance company) would not even cover extra hormonal tests such as test, e2, and thyroid hormones. This leads me to believe that I would have to get the tests done out of pocket.

I did find a RT3 test on privatemdlabs.com for 50 bucks which is not bad at all. I also found an AM Cortisol for around the same price.

Does it make a huge difference which cortisol test I have done (4x saliva or just the 8am)? If so can anyone point me to where I could have the 4x saliva test done?

I should probably call the insurance just to double check about coverage for these even though I’m almost 100% certain it’s not covered.

Money is tight but this is my health and I’d love to get all of this behind me. I’m willing to come up with the extra cash for this stuff.

Self medicating is perfectly fine by me. Also, if I did need T3 meds they would have to be prescribed by the doc which would probably take some convincing by me right? If I do need these are they something I have to stay on permanently?

I will try to have these tests done early this coming week.

Again, thank you very much for your input VT.

Most insurances will cover labs if symptoms are present…but always require a doctors order…you cant just go to the labs and ask for them or you’ll pay out of pocket…talk to your doctor or your insurance and see…

4x saliva is better if you can get it, and actually makes the 8 am cortisol blood test unnecessary if costs are concern…genova diagnostics has a kit, but quest and labcorp, I think, now offer this as well…

Self mediciating really isn’t “perfectly fine”…it is a very delicate process that would best be performed by a doctor that knows what he’s doing…when I say self medicate, im talking about sourcing the needed compounds from “gray market” sources…would definitely be better if you could find a doctor switched on and willing to work with you…

[quote]VTBalla34 wrote:
Most insurances will cover labs if symptoms are present…but always require a doctors order…you cant just go to the labs and ask for them or you’ll pay out of pocket…talk to your doctor or your insurance and see…

4x saliva is better if you can get it, and actually makes the 8 am cortisol blood test unnecessary if costs are concern…genova diagnostics has a kit, but quest and labcorp, I think, now offer this as well…

Self mediciating really isn’t “perfectly fine”…it is a very delicate process that would best be performed by a doctor that knows what he’s doing…when I say self medicate, im talking about sourcing the needed compounds from “gray market” sources…would definitely be better if you could find a doctor switched on and willing to work with you…[/quote]

Ah, understood. Since I do have this physical coming up would it make sense to see if the doctor I have currently is any good? If not I can look elsewhere. I’ll call the insurance soon.

I was doing some reading on stopthethyroidmadness which is helpful in understanding all of this. It seems as if the thyroid meds I would need would not be desiccated thyroid but probably T3 only as you had mentioned.

Do you think I should look in to getting an MRI of my pituitary or this unnecessary in your opinion?

Thank you for the input.

MRI is probably unnecessary…mostly because its very expensive

I just got off the phone with the insurance company (Cigna). The lady I spoke with said that “if it’s medically necessary it is not covered until it meets my deductible but it might be”. Yes that last sentence were her words exactly haha. She said there was also a possibility for them to cover most of it but I would still have to pay a bit out of pocket.

I’ve explained my blood work to my parents and they are very supportive of this being taken care of. They will definitely help me out monetarily if necessary. It just sucks because I hate having to depend on them/ask for money. It is what it is though.

I will call the doc on monday to see If I can get in there sooner. I just hope he’s somewhat knowledgeable and not ignorant.

As far as the whole MRI thing goes it was just something I came across while reading. Would a growth on the pituitary be reflected in blood work? I’m guessing this is something I shouldn’t worry about. I’m guessing I would have other symptoms if this was the case?

Just an update…

I just had my appointment with my doc (primary care) today. He wasn’t as ignorant as I thought he’d be. Not very knowledgeable either. He did agree that my TSH was “only slightly” elevated and T3 could stand to be higher. He seemed to play the whole thyroid thing down though. I mentioned cortisol being a factor and got sort of a “yeah possibly”. He also mentioned that my Test is definitely on the low end for someone my age. He then asked me how much protein I was consuming because too much can possibly shut down Test production (I had to hold back the lols). He said that if my test came back the same in the next set of tests that he would prescribe me some T. I quickly stopped him and explained that my T levels are probably the result of underlying causes (thyroid and cortisol) and that they needed to be addressed. He didn’t bring the T thing up again. He said that everything else looked fine.

He wants me to have all of the same tests done again to see where they are at a month from when I had the last slue of tests done. I mentioned testing RT3 and he said that its too “specific” but agreed that it might possibly be helpful… He never said anything about an 8am cortisol or the likes. He wants to see me back in a month or so.

I did some research and found a doctor in my area who seems to be knowledgeable about thyroid/hormonal issues. I’ve read quite a few reviews where people with thyroid issues talk about finally getting the help they needed from this guy. All in all, I think going to see him will be the way to go.

With this said, I am contemplating just having the tests done again (this time with RT3 and Cortisol) and going to this new doctor. I simply don’t feel like I need to waste my time going back to my primary care doc. I don’t know if he would even prescribe me the necessary meds if the numbers were right in front of his face. But why take the time to find out right? I think it’d be great to walk into a doctors office and have the doctor know more than the patient…

As always, any input is greatly appreciated.

Your saga is frighteningly similar to others’. Keep plugging away.

Agree that you should leverage your current doc to get the blood tests done ahead of your next visit with the new guy–never hurts to have more info.

[quote]VTBalla34 wrote:
Your saga is frighteningly similar to others’. Keep plugging away.

Agree that you should leverage your current doc to get the blood tests done ahead of your next visit with the new guy–never hurts to have more info.[/quote]

I should have been more specific. I am having the tests done through privatemdlabs.com because my insurance is very “ify” about whether they are covered or not and I don’t want my parents to get an outrageous bill. They said something like $1500 before the deductible or some crazy shit like that. I will have the tests done before my visit with the new doctor. I simply don’t think its worth wasting my time with my current doctor who most likely knows little about my situation. The new doc seems promising. I hope I’m right…

Haven’t updated in a while due to life and what not. I have been reading a lot on STTM which is very helpful. I also found a kick ass doctor that totally agrees with everything suggested in this thread and STTM. He is very willing to help me and hasn’t said no to any of my requests yet. I just saw him for the second time today actually. I feel extremely lucky to have found this guy. He seems very knowledgeable about hormones and believes in treating people and their symptoms, not numbers. He also loves to crack jokes about endos and his “idiot colleagues”. It’s nice to walk in to a doctors office and have him know more than you do about your issues…

He wants to work on my thyroid and adrenals to see what effect it has on my T (he agrees it should be much higher). He also believes fixing these issues will have a very positive effect on my other labs and I’m very optimistic. I just had more lab work done last week (TSH,FT3,FT4, Thyroid Antibodies, and RT3).

Results 2/22/12:

TSH 2.79 (0.50-4.30 mIU/L)
FT3 3.6 (2.3-4.2 pg/mL)
FT4 1.6 (0.8-1.8 ng/dL)
RT3 37 (11-32 ng/dL) OUT OF RANGE

FT3/RT3 ratio was 9.7 (should be 20+)

VTBalla hit the nail right on the head it seems.

I have the kit for the 4x salivary cortisol and I think it also measures dhea along with other adrenal hormones. I also have scripts for the iron/ferretin labs that I need along with a kit my doc gave me for food allergies. I will take care of them all this coming week and most likely be back in the docs office by Monday or Tuesday the next week. We both agreed that Cytomel and some adrenal support will most likely be used for treatment after we see what these next tests show.

On a side note: Strength seems to still be going up nicely. Looking to hit some nice pr’s (475/315/550 @ 198 RAW are my goals) at my meet next Sat. Not sure if this is at all relevant in this thread lol.

Any input is always greatly appreciated.

Let us know how the cortisol and iron/ferritin labs turn out.

I am still waiting for the 4x cortisol results but the iron/ferritin stuff is in.


IRON, TOTAL: 124 (27-164mcg/dL)
IRON BINDING CAPACITY: 364 (271-448mcg/dL)
% SATURATION: 34 (9-52% [calc])
FERRITIN: 62 (10-105ng/mL)

I read on STTM that ferritin should be greater than 50 which it is. But, it also said that men should/tend 100+. I’m unsure as to wether or not I have an issue in the iron/ferritin department or its more of an adrenal thing. What do you guys think?

Input is greatly appreciated.

Update and Questions:

I have a Dr’s appointment next week and had some questions I thought I would try and get cleared up before I walked in.

  1. How do my Iron/Ferritin labs that were posted previously look? Does it look like I might need to begin supplementing with Iron? If so how much? Will T3 and adrenal support take care of this on its own?

  2. My Dr said that when he does prescribe Cytomel he would like me to start it at 5mcg a day. He then said we would raise the dosage from there based on how symptoms looked. My question is, when would I take it each day? Does it matter? I’ve read that selenium can be good to take when taking your T3, true?. Does splitting the dosage help? I also read that taking it all at night can be good. STTM has very limited info on how/when to take T3, mostly just stuff on desiccated thyroid.

I will have the adrenal results posted before my appointment so you guys can check it out.

I will also probably have questions related to the dosing of HC, when, and so on. I realize this is probably useless info since there are no results on here yet.

  1. Last question. How long after I start on both T3 and adrenal support do I run thyroid/adrenal tests? How long before I look at what effect they’ve had on other hormones (T)?

Any and all input is greatly appreciated.

PureChance, I know you know a lot about this stuff and if you could chime in that would be awesome.

Thanks guys.

EDIT: Turns out I won’t see adrenal results until my appt next week. I’m assuming I have low cortisol based on symptoms though. We’ll see. I’ll post soon.

4x Salivary Cortisol:

6am-8am: 16 [13-24nM]
11am-1pm: 3 [5-10nM]
4pm-5pm: 4 [3-8nM]
10pm-Midnight: 4 [1-4nM]

Cortisol Load: 27 [23-42nM]

Well, looks like cortisol is on the low end. Not surprised. Is it odd that the last two values are the same? Also it looks like cortisol went up slightly during the day (going from 3 to 4).

I found this on STTM that looks pretty awesome in the sense that you need to use HC. T3 does its job almost. You guys don’t have to read it but its basically a T3 only protocol that also works to improve adrenal function by taking T3 before normal waking times. I’m thinking I’d like to take this route. What do you guys think?

My plan was to add Rhodiola and maybe some Ashwaganda while doing this. Also 1g of B12 a day.

Also, I read this on thyroid-rt3.com:

“When TIBC and/or UIBC are low, you MUST not take much iron so if you are still low in Ferritin a maximum of 18-27mg daily of elemental iron ONLY should be taken. As long as serum iron and %sat are good you should be able to tolerate thyroid. Possibly slowly raising the thyroid may bring the Ferritin up.”

This makes me think I should start taking at least a small amount of elemental iron.

My Doc appointment is tomorrow and I will bring all of this up to him. Any input that can be given on this whole thing would be great.

I am going through the process of rT3 clearing with use of T3.

Post your labs and symptoms on the adrenal support group, http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

They will guide you through your set up and recommended treatment that you can bounce off your doctor.

B12, vit D, iron, ferritin all need to be healthy to get results from adrenal and thyroid support treatment.

I’m picking up my Cytomel tomorrow and also getting some IsoCort. I’ll start them once I have both.

I’ll be adding 1mg of B12 a day along with probiotics. I added milk thistle a while back too. Also keeping my D3 at 10,000iu (everything else I’m taking is in the first post). I think I’m gonna buy some sea salt also.

My doctor and I both agreed on going with the T3 protocol on thyroid-rt3.com and IsoCort.

I’ll start with one 6.25mcg (breaking 25mcg tabs into quarters) dose of T3 (once upon waking) and after 4-5 days add another dose and so on until I get to 4-5 doses a day. Then I’ll begin to slowly increase each dose starting with the first (12.5mcg). I read that most people are at about 75mcg at week 8 and usually end up one around 75-125mcg around week 12.

My Doc and I forgot to talk about IsoCort dosage so I’ll have to look into that. Any help on this is appreciated.

I’ll get on the yahoo group soon. I’ve been really busy so it might take me while to get to that. I can say I do trust my doctor, but I’m always looking for more input.

EDIT: Soon after I post things on here I figure out the answers to my questions lol. I think I’ll just start with 1 pellet of IsoCort a day with my first meal and then up it to two after a week or so (morning and afternoon). The label says I can eventually do 3 morning, 3 afternoon, 2 night or 2 pellets spread out over 4 doses which sounds appealing so that I can take it before training.

I don’t know why but DHEA has been in my head a lot lately. Is it something I should have tested and possibly be taking? Will the T3 and IsoCort alone a have a positive effect on this? I’m sure I read way too much into this and should just stick with what I’m doing.