T Nation

Help with Labs - DHT High, Low Free T

Hey bros

Got these labs back and don’t know what to do next. Any advice from you guys would be much appreciated. Here goes:

testosterone, serum 548 (264 - 916)
free tesosterone (direct) 10.5 (8.7 - 25.1)
DHT 139 high (30 - 85)
SHBG 50.6 (16.5 - 55.9)
Estradiol 24.3 (7.6 - 42.6)
DHEA 232.6 (138.5 - 475.2)

T4 Free 1.00 (.82 - 1.77)
TSH 4.98 high (.45 - 4.5)
T3 Free 2.6 (2.0 - 4.4)

I am prescribed a 15% compounded testosterone cream, .25 grams per day (1 click from dispenser). Anyone know how many mgs that is per day? Me not good with numbers. I am also prescribed 25 mcg of synthroid per day, which I should probably increase given my high TSH.

As far as my symptoms, the testosterone lately has been giving me some anxiety, and also a lot of brain fog. I feel dumber, kinda slow, and just not all there. Like my neurons aren’t firing as quick. I notice this particularly right after I apply it in the AM. Libido not great either. Could this be due to the high DHT?

I’ve had some benefits from the TRT, mainly better sleep, weight loss, and increase lean muscle mass, which has been nice.

Ideally, I’d like to increase my free testosterone to see if that gives me the kick in the ass I need. I read that that Proviron could bind to SHBG and thereby increase free T levels, so I bought some of that online and should be getting that in the mail soon. My plan is to reduce my TRT dose when I add the Proviron, so my DHT doesn’t go crazy. Hoping that boosts the free testosterone up, because my level of 10.5 is garbage.

Anyway, does anyone have any advice for me on this? Best route to go? I need to feel better. Thanks guys

Your have two problems, first your high SHBG is binding some of your testosterone (Total T) which is lowering your Free T. Once you start thyroid medicine SHBG will increase needing a higher Total T to have enough Free T, you will likely need 1200> ng/dL to get have Free T in circulation.

Your second problem is testosterone is suboptimal, I would expect to see LH below mid-range. LH is the stimulating hormone for the testicles, so lower values will see less testosterone production.

You will need to manage estrogen while on TRT with either frequent injections or an estrogen blocker, I recommend frequent injections EOD, this will keep estrogen lower versus 1-2x per week which will probably see estrogen high and symptoms to boot.

High DHT is not a concern, it just means you convert a lot of your T–> DHT and should be rewarded with an insane libido and perhaps acne if you are prone to it.

You seem to be having thyroid problems, TSH is high in an attempt to get more hormones out of the thyroid, it doesn’t seem like your thyroid is getting the job done. Sure your levels are normal if we go by ranges, but don’t expect to feel good at these Free T3 levels.

Free T3 needs to be at least mid-range or 75% of the ranges, Reverse T3 should be <15 ng/dL or it will block some of your active thyroid hormone ~ Free T3. I don’t see Reverse T3 testing, this will dictate what type of thyroid medicine/treatment that is needed.

Thank you sir. I appreciate your input.

In regards to LH, is there anyway to increase those levels? I know clomid and HCG do that. Does adding either to my protocol make sense? I don’t want to overkill but like you mentioned it seems I’d have to seriously boost the total T level to reach optimal free Testosterone level but then I’d likely also have to add an AI. Could mixing in low dose clomid as an adjunct be an option rather than upping the Testosterone dose and therefore needing the AI? Or would that result in just as much estrogen. This is like wack a mole.

First DHT is what gives you many of the trt libido benefits and well being. You me DHT is not high. Second estrogen has many more benefits we want from trt so don’t block estrogen. Plenty of evidence out there not to worry. There is not any evidence to block so clarify that quickly and just do daily to avoid spikes .

When we inject once a week out body doesn’t know how to use all of what’s available for immediate use and that causes symptoms. So do daily and that’s all you need for estrogen.

Next you have to realize the body is not used to hormonal influx so give it time. Almost every trt doc and expert I know has stated their patients symptoms dissipate after 1-4 months on trt. We’re talking minor like water retention, nipple sensitivity and energy spikes. Once the body normalized you will experience the benefits of these three hormones your body creates from your trt injection.

Always remember “there is a reason my body
Creates these three hormones and they rise with one another as I increase dose: there needs to be a balance”. Trust in god; Mother Nature science or whatever. Our body is complex and an amazing machine. This is by no mistake that estrogen is increased as feee t is increased.

Next brain fog can be one of two or both. 1. You need thyroid meds like I did. 2. You need more free t, estrogens and DHT. If raising the dose does not help get the thyroid t4/t3 pills and it will help: honestly from the looks of it you could go for thyroid and j bet that’ll fix you up.

Just don’t get stuck thinking all these symptoms are from estrogen or that you need to lower your dose: you’ll never see the total benefit of trt. Many men keep their doses low and complain of all types of issues and never raise their dose out of fear.

Definitely raise trt dose and get ft3 above 4.2 or 4.4. Most men don’t feel better until ft3 is above 4 and close to 5. Just start thyroid and thank me later. I’m On thyroid and it fixed me while trt didnt do jack. It also removed my anxiety and deprrssion and chronic fatigue.

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Yes there is, clomid will increase LH, but clomid also increases SHBG and should not be attempted if you have high SHBG. Most men have terrible side effects on clomid because it stimulates the estrogen receptors and increases estrogen. HCG will do nothing to lower your SHBG, however TRT will and is your only option.

TRT suppresses LH, some have used micro doses of clomid to remain fertile, but it will increase estrogen and SHBG, not what you want.

Also you have to tackle both TRT and thyroid at the same time, TRT cannot work with thyroid problems and you will need an expert doctor to balance the two treatments. He will need to be able to differentiate the symptoms between TRT and thyroid, I see a lot of doctors go in the wrong direction and the patients gets frustrated.

Thanks, that makes a lot of sense. What thyroid meds do you recommend?

I take 25 mcg of levothyroxine

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You want to take Armour thyroid. Based on your results i would take 2 grains am and 1 pm. Or start low and it’s gonna take a while to raise dose and feel better.

Or take 1 grain am and see how you do. After 3/4 days increase dose to 1.5 and then 2 until you feel normal in energy and mood. Trust me you’ll know when it’s working.

Its easy to know when you took to much. You’ll feel nervous and sweaty palms and etc. like you took to much caffeine.

If I were you, and knew what I know today, I would get on Armour thyroid tomorrow. T4 only is nonsense. Problem for most is we have enough t4. It just doesn’t convert to t3 efficiently.

Check out DR.rouzier and thyroid on youtube . This guy trains the best hormone doctors in the world and is a master educator and physician: the docs say Rouzier has forgotten more about hormones than docs will ever learn…

What you are taking now is t4 only right? That rarely works for folks. Before big pharma they gave t4/t3. Now they don’t give it because of ignorance. But if it was 50 years ago you would of had zero problems getting your hands on dessicated thyroid.

For immediate relief try taking two of those pills. That should help some until you get more.

Add another click or 2 per day :slight_smile:

15% cream should be 150mg per gram, so one click is 1/4 of that. So 37.5mg of T. It’s not really comparable to injected T so don’t even try.

Plenty of people are on 3-4 clicks per day of 20% cream, so something like 4-5x more than you… so you have plenty of room to increase IMO

Obviously thyroid needs to be optimized as well which you’re already getting a lot of info on.

Thanks @systemlord @enackers @ncsugrad2002 . Really grateful for your guys knowledge.

Seems like figuring out the thyroid situation is top priority. Honestly, the levothryoxine (t4) has never really made me feel any better, and I have upped my dose before without benefit. Will work on getting my hands on some Armour Thyroid to see if that makes a difference. So far it’s been tough to find online, and my doc dismissed that idea when I brought it up with him originally (typical). I’ll keep looking.

I will up my Testosterone dose to two clicks per day (75 mg). I’m not scared of high DHT. I’ll let the estrogen ride. If I notice any “gyno” or whatever I’ll try some DIM or resveratrol, both of which I have on hand.

Cream has a tendency to bind to SHBG. I bet injections would solve most of your problems. As suggested though, gotta get the thyroid right too.

You are on track. Join our Facebook group and email me I’ll invite you. You’ll get tons of help on where to get thyroid online since the doc won’t give it to ya.

Where are you living in states? I know docs in north east, Florida, Texas and Chattanooga’s.

Last resort . I don’t recommend it for various reasons, but do call defy if nothing else works. You should not have to suffer because of a doc. Also call around locally and find a doc that prescribed ai. Shit go to wordlinkmedical.com and find the directory. These docs are saying they trained and went to dr.Rouzier courses … problem is not all actually practice his way of HRT like dr nichols at tier1hw.com.