Bloodwork After 7 Weeks on TRT (High TT Low FT)

My TRT protocol is 100mg(Enanthate) divided into two 50mg injections on Wednesdays and Sundays. Both shots done at evening.
Below blood test was done on Wednesday morning. Written in bold is my results and next to them is reference ranges.

Total Testosterone - 7.07 ng/mL 2.49-8.36 ng/mL
Free Testosterone - 17.87 pg/mL 5.4-40.0 pg/mL
Estradiol (E2) - 29.1 pg/mL 25.8-60.7 pg/mL
Prolactin (PRL) - 9.5 ng/mL 4.0-15.2 ng/mL
SHBG - 30.9 nmol/L 18.3-54.1 nmol/L
DHEA-S - 261 ug/dL 88.9-427 ug/dL
DHT - 377 ng/L 219 - 1080 ng/L

T4 - 6.01 ug/dL 5.13-14.1 ug/dL
Free T4 - 1.25 ng/dL 0.93-1.71 ng/dL
T3 - *72 ng/dL 83-200 ng/dL
Free T3 - 2.47 pg/mL 2.04-4.40 pg/mL
TSH - 1.16 uIU/mL 0.27-4.20 uIU/mL
Reverse T3 - 204.5 pg/mL 90-215 pg/mL
TPO - < 9 IU/mL < 34 IU/mL
Anti-Thyroglobulin ANTIBODY - <10 IU/mL < 115 IU/mL

Iron - 98 ug/dL 59-158 ug/dL
Ferritin - 83.7 ng/mL 30-400 ng/mL

Hemoglobin A1c % 5.6 % 4.0-5.6
38 mmol/mol 22-38 mmol/mol
Average Glucose 114 mg/dL

RBC 5.22 mil/uL 4.5-5.9 mil/uL
WBC 5.6 bin/uL 4.4-11.3 bin/uL
Hemoglobin 15 g/dL 14.0-17.5 g/dL
Hematokrit % 45.5 % 41-51
MCV 87.2 um3 80-96 um3
MCH 28.7 pg 28-33 pg
MCHC 33 g/dL 33-36 g/dL
These two below are out of range:
Eosinophil % 1.2 % 2-4
MPV 11.5 um3 7.8-11.0 um3

So i have couple of questions :

  1. My SHBG was around 21 nmol/L before TRT and now it’s much higher. I think it’s still in the lower/normal ranges but how come my FT is low despite high TT? How do i overcome this? Increase dosage? And by how much?

  2. 3 months ago my RT3 was 115 pg/ml and now it’s 204.5 pg/ml. On a side note I feel better compared to 3 months ago. Can it be a lab mistake? Also how come my TSH is 1.16 uIU/mL despite my very low levels of thyroid hormones. My TSH average is 2.98 in my last 4 blood works.
    I asked advise for my thyroids here before but now that my RT3 is very high i need new advise for thyroid meds. Maybe i should retake the blood test for my RT3 just in case?

  3. I have no idea what my DHT levels should be and what it refers to. Need comments on that please.

4)Anything wrong with my Hemogram? Is there something that i should be aware of or be worried ?

Thanks in advance.

@systemlord @trifive @highpull @darthmason @dextermorgan @mr.inquisitive

Normally I see a decrease in SHBG after one starts TRT, but sometimes I see a decrease and can be a couple of reasons, insulin resistance/obesity was suppressing SHBG or it was just a natural daily variation because levels are always fluctuating day to day.

Another reason could be an increase in Free T3, Free T3 increases SHBG.

Your SHBG is very sticky binding up more androgens versus the next guy, there is thought to be a variability in the stickiness of SHBG from person to person. In a biodiverse world you can’t expect any two men with similar Total T and SHBG values to have the exact same Free T levels, there is going to be variation.

Your thyroid is struggling, T4 is the raw hormone produced by the thyroid gland and should be midrange and is more than likely be why all thyroid hormones are low across the board, because there’s just not enough raw thyroid hormones being produced.

On paper this is very close to hypothyroidism. Reverse T3 is high and Free T3 is low, not good.

TSH is too high, it’s not hard to understand why. Don’t expect optimal results with regards to TRT with these poor thyroid numbers, optimal Free T3 is needed for TRT to work optimally.

I usually see these values higher in men who are optimized on TRT, you are not optimized. You need Free T at the top of the ranges or slightly higher.

Your Free T is suboptimal, this may be why DHT is lower. If you are planning on increasing your dosage, you will need EOD injections or you may very well increase estrogen which can cause negative symptoms.

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Thanks for the reply as always.

TSH in last test is actually quite close to 1.00.
That makes it confusing for me.

What do you advise as a thyroid med for someone with high RT3? Originally i was planning of taking NDT.

Also how do we explain such increase in RT3 in couple of months? From 115 to 204.5? I think i will get another test to see what’s up.

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This tells me your thyroid was already at the tipping point which TRT took to the next level, your thyroid cannot maintain demand as TRT attempts to restore metabolic rates. Your thyroid is fine when demand is low and not fine when demand is greater.

T3 medicine only, going the T4 route will only increase Reverse T3 and you have about the same fT3/rT3 ratios as you do now because you have a conversion disorder as most people with hypothyroidism do.

NDT is T3 only, good choice.

This can be tricky, in my case high insulin levels is the cause, it could be anything, even the increase demand for thyroid hormones which your thyroid is unable to deliver. Pushing up Free T3 levels will counter high Reverse T3.

Until you get that thyroid in check you are going to be hard pressed to feel optimal even on the perfect TRT dose.

Google “Stop the thyroid madness”
It’s such a great place for explaining all things thyroid and how to effectively fix it.

Have you checked your B12 levels? I take these sublingual B12 1000mcg and it’s been a game changer.

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It’s good to take folate with the B-12, and check your iron levels, the three tend to be very interconnected

What folate do you recommend? I’ll try that

I supplemented iron, vit C and L-lysine for about 4 months to get my ferritin up and it helped tremendously.

Interestingly I had inceased levels of TSH (2.5) during hCG monotherapy and slightly lowers levels of TSH (0.8) now on 90mg Testo E per week compared to preTRT (always around 1.3). Maybe the is somekind of crosstalk between LH and the thyroid.

Any folate that is just folate, not folic acid. If you use a methyl-folate, be careful with it, it is easy to overdo and shouldn’t be taken every day. Amazon has several good options last time I looked.

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My TSH doubled when I started TRT, then went back down to where I started after a few months. Not sure exactly why, but other guys have reported the same thing.

I take B-complex which includes b12 and methylfolate daily for months now. I didn’ know it was related with thyroids though.
I also supplement iron which increased my iron and ferritin lvls in past few months.

Oh well… i took it almost daily for months. Gotta go check if i did overdo it:)

The body doesn’t really absorb normal B12 pills which is why I recommended the sublingual B12 lozenges (methylcobalamin). Sublingual and subcutaneous are the best routes for absorption. I feel it almost instantly and it’s unbelievable how much clean energy it gives me. I took regular B12 pills for years and never felt shit.

From what I’ve heard with high-level doctors a combination of T3/T4 is always preferred to supplement only one so his thyroid will not be shut down. If you supplement only one you shut it down

The problem with that is his high RT3. If he’s taking T4/T3 combo then his body will convert the T4 into RT3. Taking just T3 is recommended when there is a problem with high RT3.

I also take methylcobalamin because of the metformin, 1000mcg ED. The first months I felt burst of energy, but now I feel nothing from it.

Just what this doctor said was regarding the Reverse T3 issue. A combo with much smaller amount of T4. If I remember correctly the doctor’s logic he still wanted the thyroid to continue to produce T4, didnt remember everything though.

My thyroid is not bad, but my FT3 is 2.8 and Reverse T3 was above 200 last time I checked. If I do something for the thyroid will be dessicated, one grain but after I fix the testosterone issue

With this logic maybe it’s better for me to take both NDT and T3 meds.

I really can’t decide which path to take.

SHBG. Increasing to 150mg a week would help, if not fix it.

Could be, thyroid hormones will fluctuate significantly, which you’ve noted. Always consider thyroid supplementation against any symptoms, not the numbers.

Symptoms? If you are experiencing hypothyroid signs and symptoms, I’d run those labs again, but after six weeks with the increased test dose. I would also take a T3/T4 combo if you resort to meds. You’re going to want some T4 due to its long half life, and the short half life of T3. Taking multiple daily doses of T3 is an option, but it can be difficult to keep you level without T4. The ratio is the key and the response is individual.

You likely have lower levels of the enzyme that converts test to DHT. How are you feeling with your current dosing?

No. Again, how are you feeling? A lot of moving parts, I know. Increasing testosterone will increase these levels.

Go to stopthethyroidmadness (dot) com
Read up before you take anything. If your problem is your body converts T4 to high RT3 and you want to lower RT3 then you don’t want to take T4.