rT3 is probably blocking fT3 and making you symptomatic.
When you take more T4 meds, you increase T4–>rT3
rT3 can be elevated from:
stress
illnesses
crisis
starvation diets
over training - anything beyond your current metabolic capacity
inflammation
infections
hCG: You have primary hypogonadism, so hCG will have limited effects. 250iu hCG SC EOD is a replacement dose for otherwise healthy males. High dose hCG can make things worse in a number of ways. BB guys often have this wrong and many doctors are ignorant of the downsides of high dosing.
Sleep: This as a generic is cheaper: Diphenhydramine - Wikipedia . The problem with this medication is that it wears off in about 4 hours and you wake up early. Works well at first. Suggest 50-75mg Rx trazodone 150mg which breaks to 50 or 75mg. $40 for a years worth at Walmart/SAMs. Also, time release melatonin 5-6mg can be very useful. Must be time-release as the dropping levels are the mechanism of waking up and fast acting will wear off during the night and wake you up. Locate this on drug store shelves, can be hard to find amongst the fast acting melatonin products. Magnesium supplements at bed time can also help with sleep - also can eliminate foot-leg cramps.
Please read these stickies found here: About the T Replacement Category - #2 by KSman
- advice for new guys
- things that damage your hormones
- protocol for injections
- thyroid basics
- finding a TRT doc
In ‘thyroid basics’, check your oral body temperatures as suggested. If low, you are under medicated. Cause of under medication can easily be from rT3. You can try to get on T3 only medication and serum T4 will go down and T4–>rT3 will be reduced. In this case, the T3 that you take will be blocked by rT3 to some extent. As rT4 drops, you need to reduce T3 dose. So that is tricky. Watch oral body temperatures. You need time release T3 and that is only available from compounding pharmacies. A partial step would be a desiccated thyroid product that has T3+T4, but rT4 can block that.
In your timeline, do you think that T levels dropped after radioactive iodine treatment?
- Testicular damage after radioactive iodine (I-131) therapy for thyroid cancer - PubMed
This would explain a lot.
Low thyroid function has may of the same symptoms as low T and I suspect that you are dealing with both.
By not using iodized salt, your TSH would have been high and that level of stimulation may lay the ground work for cancer as it can lead to thyroid nodules, with can then also progress to hyperthyroidism.
For the first 4 months of thyroid meds, T4–>rT3 may have been progressing and the effects of I-131 on your testes may have been progressing. When you read paper about I-131 on testes, remember that you are a sample of one and clinical averages may be of little comfort.