T Nation

Help: Low T After Thyroidectomy. Suggested Clomid


#1

Hello there,

im completely new here and not sure if im using this correctly but here it goes since im desperate. Need advice from someone who had thyroid and testosterone issues.

Summary:
37 Years old
Married, one child
Complete Thyroidectomy 3 years agol
Low Testosterone - last blood work at 144ng/dL
on Levothorixine - 125mg
on cytomel - 5mg
NO SEX DRIVE and ED
just got put on Clomid - 25mg a day

Longer read:
I began to have serious effects from the thyroidectomy months after the surgery. I was originally on Levo 125mg (still had a drive). Then i was put on 175mg because of extreme fatigue and no energy with bad lab work (but still had a sex drive). After about 6 months i started to have panic attacks. Cutting the grass i though i was having a heart attack. Went to cardiologist and was discovered the levo was too high for me and which had my TSH level at 0.04 (normal is 0.40-4.50 mIU/L). It was around the panic attacks that also began to have ED (anxiety caused, i thought). During the time that i thought something was wrong with my heart AND down there i also saw a urologist, who after running test (1 year later after the surgery) discovered my test was at 209. I came off levo for a while to calm me down, Then after running test with my endo i was put on 137mg of levo (still with cytomel) for a while. Began to battle with ED after the panick attacks and finding out i had low T. I began to educate myself on how to boost T natrually, so i though, and came up with a regimen like this:

L-argenine with L-citrulline
D3
Fish Oil
Calcium, Magnesium, Zinc
Korean Ginseng
B complex
Garlic
Tongkat ali (cyling)
Horney Goat weet (sometimes)

Here’s where it gets tricky. When i came off levo at 175mg to 137mg, i was also doing the regimen i listed. The 137mg still gave anxiety, BUT my Testosterone levels did this while getting tested between my Endo and Uro.

3/10/16 - Test 209 ng/dl
3/26/16 - Test 157 ng/dl
6/12/16 - Test 288 ng/dl
7/29/16 - Test 378 ng/dl
10/21/16 - Test 356 ng/dl

NOW it plummeted at 144 ng/dl. on Dec 2016. The weird this is that, when i was at 137 levo it was the highest Test at 378, BUT I STILL HAD ANXIETY. So my endo put me back on 125mg of LEVO, and thats when i found my T very low. I have been battling sex drive since August of 2015. My Endo seeing that im at 144 test, said its time for Clomid. Because i want to maintain fertility. I have been on clomid for only a week and IT SUCKS!!!. im not sure how long this takes, but all im getting is headaches and i feel worse. With low t i feel tired and no sex drive, but on a week on clomid i feel emotional and with headaches. I keep reading negative things about clomid like here: http://www.peaktestosterone.com/Clomid_Risk.aspx. Saying things about Clomid being an Estrogenic Zuclomipene Isomer. ANYWAY! i guess im all over the place and need some advice. CAN thyroid medicine have a positive impact on Testostarone, if so, i guess i should take more and DEAL with the anxiety? if my labs look good? Also is Clomid really safe? I dont want ANYTHING to take away more of my sex drive. If i can just get the drive back, what would be awesome for my wife and i. We plan to have our second child in about 1.5 years. Thanks in advance.


#2

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

We need all of your recent labs in list format with ranges.

Labs:
TT
FT
E2
prolactin
LH/FSH
TSH
fT3
fT4
rT3 if you have a lot of stress in your life, what you listed might be enought
fasting cholesterol
fasting glucose
CBC
hematocrit
ferritin - needed for T4–T3
AM cortisol - at 8AM

Sometimes TSH needs to be pushed quite low for some people.

Eval overall thyroid function by checking oral body temps as per the thyroid basics sticky. One can use body temps to adjust thyroid med dosing.

Were your eyebrows sparse. Still?
History of feeling cold?

Do not expect to find docs who can manage TRT and/or thyroid well. You need to gain knowledge and not be passive with the doctors.

In most USA states, you can order your own labs and pay out of pocket.

We do see some clear cases of low thyroid function reducing T levels and proper thyroid meds leading to better T levels. But often not. But there are many who come here with T levels and low thyroid function, that you have to wonder.

Many have issues from not using iodized salt which can lead to hypo and high TSH, leading to nodules that can progress to hyper and in some cases auto-immune diseases or cancer. Note that selenium deficiency sets one up for those last items.


#4

Hi I also had thyroiodoctomy and had ED after surgery. I will write what have you check, it exist big chance that you will recognize the reason of your problem, in my situation it is primary emty sella syndrome.

1.Take one dose of you levothyroxine for two weeks (175 or 137, or any other), do them 6 weeks after last clomid pill
2. Check one day at once: TSH,FT3,FT$,rT3 (if available)- don’t take levothyroxinein morning before bloodtest-write them on this forum
3. Do you at once with parameters which i mention above or one or two days later.
LH,FSH,Testoterone, Estradiol, ACTH,Cortisol,Dhea-SO4,Prolactin
This may be pricey but with this labs you check all factors, every internal organ which is connected with hormones - you also save money, beacuse instead of doing one bloodtest without context, you will do all them at once and have whole story of your body. Learn my faults. If I could, I would start do this labs at once as soon as I recognize first symptoms. And If doc will try to persuade you to not make them, he’s wrong beacuse they learn them to not think. They just do protocols and not think about reason of problem.-write this on this forum

4-. Please do if you can after all this labs. THEN you do MRI of pituitary gland, not head, just pituitary gland (without this I wouldn’t recognize I have partaily emty sella). Note on your MRI description the pituitary size. If everything with pituitary will be perfect than you will have to check your adrenals.

-5. Take clomid 25 mg or 50mg for month (depends on your doctor), day after last pill repeat all labs I mention before.

6 .First test to check adrenals is dexamtaosone test. You can do also MRI of adrenals. Also synthACTH test.

do those steps in the way as I wrote, it is designed on my experience, and is as cheap and efective s it can be.
Three first steps are the mos important now.
Update your status and we will try to help you.


#5

What other medications are you on? Some of them can lower Test.

Test is linked to thyroid activity, to the extent I know my own low test was cured by T3. So 10yrs of depressive hell, 5yrs on TRT and suddenly a Doc says you don’t need that, you need this and it will fix it.

T3 therapy is still largely an unknown for most docs. They live in the dark ages and don’t want to prescribe it. It may be you are on the wrong drug and need T3 not T4. Without knowing what meds you are on and seeing your bloodwork (& even with it) it’s a guessing game. It is certainly worth asking the question next time you see your specialist. Oh and when they say yes your levels are fine, they are within the “normal” range, tell them its not working for you. You can be normal and still in hell.


#6

He is on 5mg


#7

wow. wasnt sure if anyone was going to respond. Thanks for the response. I will have to get educated on the suggestions and get organized. I did want to post my latest blood work from my endo. as i stated these are my medications as of now:

Levothyroxine 125mg
Liothyronine 5mg
Clomid 25 a day ( I only took it for a week, it gave me NO libido, and horrible Headaches, although i was already having no libido and didn’t want to make it worse)

Current Testosterone at 144 ng/dl

I also want to add that I even took Cialis 5mg and it didn’t work. The anxiety and loss of libido is killing me. Cialis was working pretty good before the report of TESTOSTERONE 144. When i was about 378 Testostarone i could at least get it to “work” even with 2.5 cialis. Right now i have NO DRIVE, NO LIBIDO, and bouts of rapid heart and anxiety. So even with these issues the mental aspect of “performing” also gets me. Anyway i wan to post the latest blood work to see if you guys can see something there. I see here that you all on this site take blood work like its nothing and test things i’ve never heard of, so i will try to follow your instructions. Thanks again guys.

this is my latest blood work. I wanted to also add, that these issues didn’t start until last Aug 2015, thats when i was taking 175mg Levothyroxine and it gave me what felt like heart attacks. SO thats when this whole mess began. Visiting my Endo, Cardiologist, and Urologist, where it was first discovered i had LOW T. I remember always having some “performance” issues in the past before the Thyroidectomy, but it always only lasted like a week then when i was able to perform i was BACK. So its been more than a year with Libido/ED issues. I would love to get leveled out and find some hope to this mess. Do any of you recomment i continue on Clomid 25 ED, or EOD, or twice a week? i VERY concerned about the LIBIDO issue of CLOMID. I know it will raise my T, but on it for a week and it ONLY gave me headaches and a weird depressed feel. NOTHING about raised T.


#8

I missed that cheers.


#9

As your T3 & T4 are normal, and Clomid is poorly tolerated then its time to discuss TRT with your Doc. Ask the question and tell them the sides of Clomid are intolerable.


#10

thats the thing, i want to have kids in about a 1.5 years. Just waiting on the wife to finish her current promotion and we’ll start to try. So for my situation its tricky to be on TRT. The docs don’t want to admit that i’ve been a mess since the thyroidectomy. They said one had nothing to do with the other. After research: WRONG! I will def check my pituitary gland like 49perccent said to do. Thats a great idea. But if it is small what other things can i do? i will do what i can to not be on TRT until we get pregnant. But thats not a while from now.

again ill have to check what damage the thyroidectomy has done to my pituitary. Thanks again.


#11

fT3, fT4 are a bit sub-optimal.

What are your oral body temperatures as per the thyroid basics sticky. Body temperatures may indicate that more thyroid meds are needed or another complication.

I have asked for oral body temperatures before as well. This is not trivial.

Clomid makes some guys feel like shit. This is explained in the stickies. You may need to take Nolvadex that does the same thing. See the HPTA restart sticky for more info re SERM use. Clomid 25mg/day could easily simply be too much. In any case, LH/FSH, TT, fT, E2 labs while on the SERM will be informative to see what it is doing - after one month.

When on thyroid meds, dosing needs to push TSH to at least 1.0 and often lower.


#12

My temperature is always around 97.7. I will start to monitor in the morning and at night. I have an appt with a new endo next tues 1/3/17. I will post on here. I will also try clomid 2.5 at night twice a week and see the sides effects.

Also i just recalled before my endo put me on levo 137mg, he gave me a trial with SYNTHROID 137mg for 6 weeks. I had no anxiety and felt ok (testostarone was still low but at 378ng/dl). So it may also be that synthroid was better than levothyroxine.?


#13

I saw a new endo, and i have some tests coming up. I will post on here for once the results come in. I came off the clomid (new endo’s instructions). The new doc has ordered some new tests now that im back on 137 synthroid - brand name. She also wants to check my pituitary and has ordered and MRI along with new complete blood tests. My temperature has been around 97.5 and sometimes 95 degrees. while im waiting i have also purchased Testro x to see if it does anything. I will update on all new tests.

this is the label to the testro x.


#14

Hey guys just some updates and asking for more advice. So my latest labs as of 3/21/17 were:
FSH 3.90
LH 3.9
Testosterone 271
TSH 0.281

In my previous posts i described anxiety, which has been cured by taking Brand synthroid vs levothyroxine. So i have almost 2 months free of anxiety.
Now I continue to have Low t issues and i refuse to get on Synthetic Hormone since id like to have another child so. after trying clomid (which i hated) i kind of gave up. I will be seeing a new urologist and already seeing a new Endo that can take my low T seriously. The last test at 271 my endo said was “normal” i know i have to move on. So here’s what i want to try. I did have some good sides with clomid but very quick the zuclomiphene in it kicked in and very low libido began ever worse. So! im very interested in Enclomiphene citrate that i got from geopeptides, which is ONLY clomiphene but being that its a research chemical, i won’t take it until i speak to a doctor. I also have a friend that takes HCG and swears by it, he says it keeps producing T naturally and keeps fertility but he stated that it takes a toll on the liver. So my questions is which would be best according to you guys on here: Enclomiphene only, Nolvadex, or HCG for long term? i do not want to consider Synthetic T until i have another child. Please let me know which would be the best option for Fertility,


#15

Decent LH/FSH and low TT means you have primary hypogonadism.
Free Testosterone [FT] not tested. If SHBG is elevated, T status would be worse than TT implies.

hCG is good for your Friend. But you are primary hypogonadism, your testes are responding very poorly to LH and hCG will have the same problem. You need to understand your problem better. hCG does not create any liver problems, your fiend’s liver problem is something else. hCG is a natural human hormone.

hCG or a SERM will not restore the kind of T levels that you need.

hCG or a SERM can preserve your testes and fertility when on TRT.
hCG is better that SERM’s as a human hormone.

“Synthetic Hormone, Synthetic T”: Testosterone is a natural human hormone and it does not matter if it came out of your testes or a bottle, it is the same thing. Testosterone esters [cypionate, ethanate/enanthate] are soluble in oil and when injected and absorbed, the ester groups are removed and you get bio-identical testosterone.

I feel that you should have understood this from reading the stickies.

Your best treatment would be:
self injecting 50mg T cyp/eth twice a week, subq, not IM.
250iu hCG subq EOD
0.5mg anastrozole at time of T injections

You did not get E2 or prolactin tested…


The only advantage I can see over Clomid is that it might avoid the estrogenic side effects that some males experience. Otherwise the product is a pure profit play with no really benefit. Will cost a lot more money and I would be skeptical about a research chemical that claims to be this (E)-enantiomer of clomifene. Too much hype!


#16

KSman

Thanks again for your input and advice. This whole Testostarone thing is getting really frustrating. I belive my free Testostarone was about 40.1. But there are somethings i actually did not mention, bc the doctors said it did’t matter but it looks like it does. Im a bit concerned that you said i might have primary since the ONLY option would be Testosterone itself and id like to keep fertility. BUT

  1. I did take clomid 3 times in the past month, could that have elevated the FSH and LH a bit to show that they were decent? i quit clomid and never took it the way im supposed to.The reason for this question is my FSH and LH just one month before in February was:

FSH 4.10 mIU/mL on a chart of 0.95 - 11.95 mIU/mL
LH 1.8 mIU/mL on a chart of 0.6 - 12.1 mIU/mL

Then in March:
FSH 3.90 mIU/mL on a chart of 0.95 - 11.95 mIU/mL
LH 3.9 mIU/mL on a chart of 0.6 - 12.1 mIU/mL

So IF i was secondary could clomid have started a cycle of sending more signals? My doc even said she believed me to be secondary, which other options could help.

  1. I cannot believe i didn’t mention this, since my Urologist said it wasn’t connect. BUT on my first post i put that i had a thyroidectomy and thats when things went south, but i dind’t mention that also in 2015 i had Epidydimitis. I had this infection 3 times from lifting and treated with antibiotics, now i have almost 2 years of just pain on a off, and Doc did and ultrasound and found that now it is a small cyst. these were his notes:
    “Findings: The testicles are normal in size and echotexture with normal internal blood flow on color Doppler ultrasound. Low resistance arterial waveforms demonstrated bilaterally. Incidental 5 mm left epididymal head cyst. No hydrocele.” So i guess that cyst its whats making me hurt, he didn’t say to remove it just yet, due to a risk of infertility. NOW if you’re right and i Am primary, could this be causing my Testes to not work correctly? If i don’t lift anything it seems to go away, but me trying to keep my test a decent levels i workout and always to put ice or heat down there for the pain.

Man all i want to do is have my libido back after 2 years. It takes a toll on the wife, and we’re really close to about to start trying for another child, so im deathly afraid of infertility, but how are we gonna make babies if my soldier and libido won’t cooperate? ha. Anyway thank for your info, so glad there are forums like this. Doctors just want to dismiss people to get to the next patient, can’t find one that can tackle this head on. My urologist only sees my cyst and wants cialis, and endo thinks my Testostarone is normal to live in the low end, (i have 2, since one is a woman). My endos are only concerned with my thyroid since thats what they need to follow up on. Thanks again.


#17

just wanted to update some labs that i never took and about to start clomid, but want advice due to the labs.

Current labs not taken before
Prolactin 11.8 ng/ml
Estradiol 13 pg/ml

Latest T levels: 336 ng/dl
fsh 3.90
LH 2.1

basically from my last posts of last year i’ve lived around upper 300s for Testosterone. The Doctor keeps pushing me to begin clomid for a year. Im about to start being that i still struggle with everything i have before. But never had prolactin and Estradiol checked. Anyways…being that Clomid will have lots of Estrogenic effects…I want to start on a low dose vs what the doc wants.

Would you guys see 12.5mg M,W,F to being better than the prescribed of 25mg ED and 25 mgEOD?
Also Doc never tells me if im to do this as a cycle to rest from clomid or straight on long term. Being that im around upper 300s would cycling for 3-6 months better than just going for it without stopping?


#18

It’s because that’s what all they know, most endo’s don’t know anything about TRT. Otherwise they wouldn’t be telling you the 300 ranges are fine, maybe for a 90 year old.

You might need to find a non-insurance doctor, their trained to be robotic and not think for themselves. To follow what they were taught and not do anything more, this means never learning anything new like male hormones.