HPTA and Fertility Restoration

[stevo213]

I have been B&Cing for about 3 years with low doses of Test E (200mg) and Tren E (200-400mg) and occasionally throwing in Mast E (200mg). I have used HCG throughout but there were certain periods where I did not. After a while, my testes began to atrophy and I felt like HCG was not keeping them 'plump'.

It is now time for a baby and I had a test come back very low (2mil).

I am 26 years old, 115kg and 14% bf.

Stupidly enough I followed Scally's Power PCT (Large 2500iu EOD blasts of HCG with aromasin) and ended up with the following results:
Prolactin 242 mIU/L (45 - 375)
Oestradiol 95 pmol/L (< 150)
Testo 21.5 nmol/L (6.0 - 28.0)
SHGB 45 nmol/L (15 - 50)
Free Test 380 pmol/L (200 - 600)

I did another test during week two of SERMS (100mg clomid/60mg Toremifene) with the following results:
E2 LCMS 26pmol/L (40-160)
IGF-1 21nmol/L (15.3-43.1)
DHEA 6.4 umol/L (4.8-13.9)
Test 15.3 nmol/L (6.0 – 28.0)
5D 48 nmol/L (15-50)
Free T 247pmol/L (200-600)
Vit D 71nmol/L (over 50)
FSH 8iu/L (1-8)
LH 5iu/L (2-8)
E2 110pmol/L (<150)
PRL 9 miu/L (45-375)

I now see that high dose SERM usage is probably the reason why my balls are still atrophied due to the overstimulation of LH. I am now going to drop down to 12.5mg clomid EOD and see what happens.

My goal is fertility, then I may look into a TRT route as i believe i may have done some damage from my stupid AAS use. I do not have access to HMG unfortunately.

My questions are:
1. Should I add DHEA into the mix?
2. Why is there such a huge difference with my E2 tests which were taken on the same draw? Is my SERM use throwing off these values?
3. I was using Aromasin 12.5mg E4D and it brought my E2 to the levels above. I felt like it had crashed me so I stopped. Should I use 6.25mg E3D?
4. If i were to switch to Nolva instead of Clomid, which dosage should I go for?
5. I am supplementing with ZMA, Vit E, D, C. Should I add anything else?

Any help would be greatly appreciated.

[KSman]

There is also a HPTA restart sticky.

Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

• advice for new guys - need more info about you
• things that damage your hormones
• protocol for injections
• finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body's temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

[stevo213]

Thank you for your response.

I also did a Thyroid test:
FT4 19.1pmol (9-25)
TSH 1.3 miu/L (.5 - 5)
FT3 6.1 pmol/L (3.5-6.5)

[KSman]

fT4 and fT3 are well above mid-range target.
fT3 is the active hormone.

Please provide the requested oral body temperatures, AM and mid-afternoon

Your history of using iodized salt is important.

[stevo213]

@KSman apogies for the lack of info, see below:

Age: 26
Waist: 34"
Weight: 115kg
Hair: mesomorph, thick dark facial hair (European).
Fat: I carry most of it in the love handles while my upper body can stay fairly lean
No health conditions
No propecia or hairloss drugs. I did use Saw Palmetto at one stage though. Nothing too frequent.
Labs posted previously
Good balance of protein, fats and carbs. Mainly complex carbs. Minimal sugar. Lots of meals.
Weight training 3x a week, moderate.
Teste's atrohpied.
Morning erections present but not very hard

Other notes:
Dehydrated in the mornings, strong yellow urine.

[stevo213]

I will buy an oral thermometer and report back.

I use mainly Himalayan Rock Salt, not Iodized.

Note: I have also used T3 before as a supplement/drug for fat loss purposes up to 100mcg during my AAS use.

[stevo213]

Update:

Bought a thermal thermometer.

Result:
10am = 35.4 degrees celcius = 95.72 degrees farenheit

Edit: measured morning temperature incorrectly. New measurement at 1:20pm = 97.3F

A few other notes that are now starting to make sense to me:
- I have been very sensitive to the cold lately
- Dry skin/lips
- ED
- Low libido
- Low energy

[stevo213]

@KSman
Update:

Yesterday afternoon: 97.34 degrees F

This morning upon waking: 97.16 degrees F

Started taking 50mg of Lugols Iodine yesterday with 150mcg Selenium

Question: What else should I do from here? I haven't been taking in any Iodine until now. Will Iodine be detrimental to my levels as my FT3 is above mid range?

[stevo213]

@KSman any further advice?
I suspect high rt3.
Going to get saliva adrenals tested along with full thyroid panel again

[stevo213]

BUMP:

Does anyone have any feedback for my results/situation?

I have 100 x 25mcg T3 tablets on hand if needed.

@KSman sorry to bother again but do you have any suggestions?

[KSman]

You are correct re probably elevated rT3.

Do not do a thyroid panel, let the iodine do its job.
TSH will be high from the iodine and for some time after IR.

If you have adrenal fatigue, more T4 may lead to more T4-->rT3 and then temperatures may not increase. Read the thyroid basics sticky noting rT3, stress, adrenal fatigue and Wilson's book.

There is no useful amount of iodine in natural salts or sea salt.

Your low thyroid function symptoms may also include sparse outer eyebrows.

I take T3 time-release 25mcg once a day. I had presumed rT3 issues as iodine stopped working to maintain my body temperatures and desiccated thyroid did not work either.

Who else is living with you who also has iodine deficiency?

You should get more fluids in the evenings before going to bed.

[stevo213]

Thank you for your reply @KSman

I went to see a Naturopath but only to get an adrenal test saliva test done. Will let you know results for DHEA and Cortisol.

Would you recommend 12.5mg T3 2 x a day?

I also realised that HCG wasn't working like it did before in increasing testicle size. Do you think my undiagnosed hypothyroidism had something to do with this?

Should I go back on a TRT dose of test with HCG until my thyroid levels are back to normal? My goal is fertility and I have been on SERMS for about 5 weeks now. I don't want to start from 0 again but maybe it's a waste trying to do a SERM restart with an under active thyroid?

[KSman]

12.5mg T3 2 x a day:
You mean 12.5 mcg T3
or
12.5mg iodine?

[stevo213]

Mcg sorry

What are thoughts on restarting with HCG again as per your sticky?

[stevo213]

Hey @KSman, what dose of t3 do you think would be good to run until rt3 is flushed out?
I am also going to follow your TRT protocol as there's no point struggling with SERMS while my thyroid is under active.

[KSman]

Pharma T3 in USA is fast acting, not ideal. Time release is a compounding pharmacy only item in USA. 25mcg seems to work for me.

As you take T3 and rT3 decreased because T3 is suppressing TSH and thus T4 to reduce T4-->rT3, the effect of T3 increases as there is less rT3 interfering with fT3. So you can see how dosing cannot really be firmly suggested as there are so many other things going on. Body temps are your guide and if you feel jittery, you know T3 dose is too high or has become too high.

I take T3 in the AM so that levels drop during the day so I am calming down in the evening. Find what works for you and your sleep patterns. My time release T3 of course has a different dynamic in this regard.

Do not understand hCG question. Never take large doses, 250iu subq EOD gets the job done. Do not stack with SERMs or take large SERM doses.

Wrong! "100mg clomid/60mg Toremifene"
- you know that now...

More iodine will support higher T4 that may increase T4-->rT3
So more complications.

You seem to be doing a good job with your learning via the stickies.

[stevo213]

Thank you for the detailed response @KSman

I understand the no SERM + HCG rule, I just meant instead of waiting for my rt3 to clear while attempting to restart HPTA, it's probably better to run a TRT dose of test a week along with 250iu HCG until the thyroid function is restored.
Once my thyroid is functioning again, I can look at restarting with SERMS. Does this sound reasonable to you?

I'm also limited to fast release t3 in Australia unfortunately. Our doctors don't think outside the box here.

[stevo213]

Hi @KSman KSman, hope you are well.

I have some updated Thyroid results:

TSH 1.04 uU/mL
FT4 13 (9-19) pmol/L
FT3 4.7 (2.6-5.7)
Reverse T3 437 pmol/L (170-450)
Reverse T3 Ratio = 10.1 (not good!)
Thryoglobuln 124 (high) < 84 pmol/L

I started taking T3 50mcg split throughout the day after these tests 3 weeks ago, however I only received them today.

Should I continue T3 for 12 weeks and re-test?

[stevo213]

Hi again @KSman
I had an update on my cortisol levels.

Morning 32.8 (6-42)
Midday 5.5 (2-11)
Afternoon 2 (2-11)
Evening <1 (1-8)
DHEAS 11.1 (11-76)
All measured in nmol/L

What would you suggest be done from here on?

[stevo213]

Hey @KSman. Any thoughts on the above?