T Nation

Can Hypogonadism Cause Thyroid Issues (Specifically High rt3)?

Hi all,

23 years old
Drug-induced bodily damage (antidepressant and antipsychotic use). Been off for three years now with little improvement.

To preface this, I’ve read KSman’s thread on thyroid, browsed through the content on ThyroidMadness, and generally done my due diligence regarding the enigmatic thyroid.

I have decided that TRT is likely the correct route for me, given that even when – through healthy lifestyle and diet – I reach “good” hormone levels (total in the 600s and FT in the mid to upper quadrant of the range, with estrogen sitting in the middle of the reference range), my sexual function is still severely dampened.

My body is quite messed up from previous psychiatric drug use. The T numbers posted above have been my highest tested (have fluctuated a fair bit), and I felt better, sexually, the higher they got, but those numbers are probably realistically as high as I can get naturally. Thus, I want to see how I feel on supraphysiological doses of T (something like 150-200mg per week).

Recently, my body temperatures are low (high 96s in the AM and high 97s in the PM) and my rt3 is high – 19 with a reference range of [9-23]. All other thyroid indicators (ft3, ft4, TSH) are decent. I’ve looked into various causes of high rt3 but don’t meet the criteria for any of them.

While I know it’s possible for low thyroid to cause hypogonadism, is the converse true?

Is it possible for hypogonadism/lack of hormones to cause high rt3?

If so, maybe jumping on TRT right now is the move. However, I don’t want to mask my symptoms with T or be playing with thyroid hormone at the same as I’m trying to dial in. Too many variables.

I know some of you are quite knowledgeable on these systems and take supplemental thyroid (and obviously TRT) yourselves. How would you approach this?

In the past, I trialed a T4/T3 blend in a 2:1 ratio, and it made my symptoms worse. I suspect most of the T4 converted straight to rT3. For that reason, I’m thinking of testing straight T3 and seeing if I can improve any of my current hypo symptoms.

After that I optimize my thyroid, I would then start T.

Any thoughts appreciated!

That was a waste of your time.

Time better spent, it actually has some content worth reading.

There aren’t any, might want to try that part again.

It would be highly unlikely that hypogonadism would cause thyroid problems or vice-versa. It is entirely possible that they are both occurring because of the same root cause.

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Have you checked your cortisol levels via 4 point saliva test? Chronically elevated cortisol can both suppress androgens and increase T4 -> rT3 conversion. You could consider evaluating your adrenal health before hopping on TRT. If you were on psychiatric drugs for anxiety and have not resolved the underlying mental health issues this could cause this outcome.

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You all seem quite knowledgeable when it comes to thyroid, based on other posts I have read from you. Do you have anything to contribute to this conversation?

Any help greatly appreciated. Thanks!

Yes, I’ve checked cortisol in both serum and via 24-hour saliva panels. Results were normal. ACTH was, too.

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Thanks for the reply.

I have heard of cases of hypothyroidism-induced low T, as t3 is necessary for the formation of pregnenolone and thus many hormones downstream as well.

Anyway, If there is some third variable underlying both, I don’t how I would unearth it with otherwise normal bloodwork.

I suppose it’s possible, but I don’t see even an association between them. Maybe both, low test and high rT3, if an underlying illness is present. I doubt rT3 is your issue, unless fT3 is low. But, then it’s low fT3 that’s the issue.

As you may know, many low testosterone symptoms are also evident in low thyroid patients. It can be frustrating when determining which route to go. Some say TRT will not work until you “fix” thyroid, but I have not seen that at all.

Most of the time, TRT resolves symptoms even in the face of suboptimal thyroid levels. Thyroid levels fluctuate, of course, but I’ve seem them improve with TRT.

What I have seen, for example, is the guy with low within range testosterone and thyroid numbers. I generally prefer, not always, to start with one or the other and usually the guy will want TRT. They get results, but not great. Strength is up, they gain some muscle, some weight, libido is up. But, energy levels don’t seem to be there and they cannot lose fat. Maybe sensitive to cold as well. Adding thyroid to the mix makes all the difference.

By the way, your 2:1 thyroxine/thyronine ratio seems very low. Doubt T4 to rT3 conversion is the problem.


Thanks for the information and being an excellent resource for this community. With regard to hormones, it seems ignorance in the medical community is the rule rather than the exception, unfortunately.


Now, ignore/forget everything KSMan said, that’s #1 most important.

I’m sure you already know most docs won’t prescribe at those levels, but if you’re already miserable and not opposed to it then hey, try it and see what happens. I’m sure there are TRT clinics that would let you try it out and see what happens. I kind of question whether it would help but I don’t really see much harm in trying it if you already feel like crap and think it might help.

Did you post any of these values? What are they?

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Why do you question the idea that TRT could help me? I’ve had several labs done. While all were in “normal” range, we all know the ranges are garbage and that serum levels often aren’t indicative of symptoms (especially in cases of hormonal issues from endocrine-disrupting drugs such as finasteride, accutane, SSRIs, and other psychiatric drugs). I have the same symptoms as everyone else suffering from these conditions (libido loss, ED, shrunken testicles, midsection weight gain (always very lean previously), poor mood, etc.).

Across several labs, these are the general hormonal trends:

  • TT is typically 500-700 (not primary) RANGE [264-916]
  • FT is ~15 RANGE [9.3 - 26.5 pg/ml]
  • SHBG always a bit high ~ 50 RANGE [16-55 nmol/L]
  • E2 is typically around 25 RANGE [7.6 - 42.6 pg/ml)
  • Prolactin ~7 RANGE [4-15 ng/ml]

While these are my average numbers, they have fluctuated quite a bit.

I had a week where I felt significantly better than average, sexually and emotionally (but still not near where I was before psychiatric drug use). I decided to immediately take labs to determine what was happening under the hood, and it turned out that my TT was in the low 800s, my FT was 24, and my estradiol was 28 (check against same reference ranges above). Given that I did notice significant improvement when I was able to achieve a higher hormonal state, logic follows that exogenous hormones may help me achieve relief from some of the symptoms plaguing me, if not cure them over time with the correct protocol.

So, you may ask, if my body is capable of naturally producing these hormones, why do I want to take them exogenously? Simply because even with these high normal levels where I felt significantly better, I still didn’t feel close to where I was before psychiatric drug use. I believe using high-dose TRT may be able to get me there, if dose-response follows anything of a somewhat linear trend.

I know there are a number of you here with so-called “normal” numbers who were symptomatic. As someone here before said, symptoms, not numbers, should be treated.

A lot of people have thrown around theory that these drugs cause alterations to the hormone receptors (silencing, desensitization, partial androgen insufficiency – whatever you want to name it). A number of studies have shown that mutated androgen receptors do not properly autoregulate / express themselves in a typical hormonal environment; rather, they require the presence of higher androgen levels.

Now, it can be debated all day what causes these “post-drug syndromes.” No one knows. But if we look at the anecdotal evidence, it seems hormones have the best track record when it comes to successfully treating them (whether it’s HCG, SERMs, DHT-derivatives, or TRT). That’s why I’m here.

Latest thyroid numbers:

T4 - 1.29 [0.8-1.77 ng/dl]
TSH - 1.3 [0.45 - 4.5]
FT3 - 3.1 [2.0 - 4.4]
rT3 - 19 [9.2 - 24.1]
T3 uptake - 24% [24-29%]
Thyroxine binding globulin - 18 [13-39]

How long were you on the psychiatric drugs for?

I’m trying Pristiq & Seroquel to treat my PTSD (I may or may not have PFS), this thread is making me seriously rethink that … my attitude has been to treat my symptoms as if PFS does not exist.

You could try HCG first before shutting down your HPTA with TRT. You have young balls and they likely can produce large amounts of test. I was able to get my total testosterone up to about 1300 ng/dl, with HCG, you just have to be careful with your E2 management. HCG also pushed my SHBG down from 54 to 33.

I’m sorry I don’t have any good advice to give you, I just want to say that I’m on a similar journey to you and would appreciate it if you update this thread and tag me if you end up figuring it out.

I was on the drugs for two years. I would look for any alternatives to psychiatric drugs if possible. With that said, if you absolutely need them, some are safer than others. MAOIs are probably the safest (and most effective) class, but doctors typically don’t prescribe them as first-line treatment.

Stay as far away from SSRIs and antipsychotics as possible. Too many people have been destroyed from these drugs. Finasteride is probably the only more harmful drug.

How long have you had these issues?

I’ll keep you updated.

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Thanks I will consider alternatives,

You could get @systemlord’s opinion on your labs, he is very knowledgeable and has helped me out a few times when I first crashed.

I do think your FT is low for your age. It’s very interesting to see your high SHBG, I have seen a common theme in Post Drug Syndromes where SHBG is elevated, mine included. It’s worth a shot with HCG or TRT to boost FT and see how you feel imo.

Consider having a PCT plan in-place should you change your mind and want to restart your natural production. You’re only 23 and TRT is obviously a lifelong commitment.

Good luck man

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I read through your entire recovery thread and am extremely happy for you. You’ve made great progress. Why risk it all by taking antidepresssants and antipsychotics — two classes of drugs that fuck up your hormonal profile and are known to have post-drug syndromes of their own resembling that of PFS.

Many of your symptoms resonated with me. I, too, have testicular atrophy, feelings of an extremely low stress threshold, fatigue, sleep issues, in addition to all the sexual issues.

I considered clomid and HCG, but my HPTA appears to be working ok. LH is normal and I’ve demonstrated that I can get to my T into decent ranges yet still not feel optima

TRT + T3 is something of a last-ditch effort to correct this.

I’m really at my wit’s end. I don’t know how much longer I can endure this relentless nightmare if I cannot find improvement. I’ve been to tons of doctors and have not been taken seriously. I’m exhausted.

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I really appreciate the advice man. I was turning to psychiatric drugs as a last resort; my tolerance to stress & stimulation is so low I can’t even look at the computer screen without triggering that stress response, my nervous system is just fried. I was seeing major progress with the protocol I was following, but I got desperate, impatient and was looking for a quick fix. There has to be another way …

Just wanted to say keep your head high and never give up man, exhaust all options, try all therapies, always be grateful for what you do have and do your best to keep a positive mindset.

Do you have any addiction? Weed, meth, porn? If so, how much/often?

Somewhat, you don’t know what you don’t know. I think it is ignorant of the public to go to a generalist, or even urologist or endocrinologist, and expect TRT specialist work.

Maybe it’s not a good analogy, but I have a patient who is a mechanic. He works for a dealer and all he does is rebuild transmissions. He’s really good at it, twice as fast as others and his work does not come back for warranty repairs. He could overhaul your brakes, but someone who does only brakes is probably a lot better at it.

I’ve related this previously, I have some high up the food chain medical specialists, extremely smart people. In going over lab results, options and making recommendations, I’ll always tell them I’ll skip over a lot of the basic stuff since, “you already know”. Invariably, they will say, no, talk to me like a layperson. I don’t know any of this.

My issue is with some of the crazy stories we hear, such as a GP dabbling in TRT and putting a guy on every day 1mg anastrozole. Or giving a once monthly, or bimonthly injection of 100mg. That’s a problem.


Regarding the question of having both hypogonadism and thyroid problems, yes this is totally possible if they are both secondary. I have problems with both to varying degrees, but chose to treat testosterone as it’s created more symptoms for me. Both the testes and thyroid are regulated by the pituitary gland and hypothalamus, if something is amiss with the pituitary, it can cause problems in both glands.