T Nation

Hypothyrodism or Hypogonadism? Or Both? Lab Report Included


#21

I am always reluctant to see a person get on a life time of thyroid medications when the root cause might be a simple case of iodine deficiency.

Iodized salt in prepared foods or restaurants is probably very low. So you missed out there.

Avoiding dairy means no iodine from that and also missing Vit-D3, calcium and magnesium.

Vein problems in your testes does not explain why LH/FSH is low. You appear to have secondary hypogonadism and that is not explained by high E2 or high prolactin and thus not correctable by lowering those.

Supplements:
Vit-D3 5,000iu per day

  • others you planned, Multi-vit should provide B vitamins

Serum iron is not something that calls for iron supplements. Also need to look at RBC, hematocrit [relative to T levels], hemoglobin and ferritin. Serum iron can lead to false lows and false highs. We like to see Ferritin=80 ng/DL and you are there. That number is thought to support T4–>T3 conversion.

So you need to reconsider some parts of your plan.

Lab testes for iodine, selenium and zinc can pay for the supplements you probably need to take anyways.

I think that you are suffering from that diet and probably in ways that are not addressed in this thread. You probably also need natural source Vit-E, Vit-C, fish oil caps, other antioxidants. You can focus on learning about supplements to back fill problems with your current diet.


#22

do you assuming that low thyroid function can not be the cause of hypogonadism? as far as I know hypothalamus-released TRH stimulates both TSH and PRL (which in turn inhibits gonadotropins).


#23

We had a couple of cases where young man HAD to get on thyroid meds and T levels recovered *. But lately we have not seen any similar outcomes. So while this can happen, I have reluctantly concluded that you cannot count on that happening; others here offer same conclusions. But I need to point out that low thyroid function undermines the function of every hormone system in your body and also affects brain, hypothalamus and pituitary. So things can broadly work better.

(* When this does happen, the recovery may not be to levels that are high enough. You might just be then “normal” enough to not get treated by one’s doctor.


#24

Thanks, @systemlord and @KSman

Based on research in reading several threads here and your thoughts, I’ve begun taking Levothyoxine 100mcg. Today was my second day of taking it. I don’t feel any different yet but I suppose it’d take several weeks. I’d get lab-tests done again in about 6 weeks to see what difference it makes.

For supplements: I will be starting:

  • Vitamin D 4000 IU (I’ve bottle of 2000 IU so 2 x 2000IU)
  • B Complex (Nature’s Bounty super B complex, about 1100% of RDA B12 + other B vitamins)
  • Thyroid support (has idoine, selenium, ashwagandha etc)
  • Iron (but not every day, perhaps a couple of times a week)
  • Zinc 30mg (2 x 15mg of Zinc Balance - Jarrow’s formula)
  • Vitamin E

I’ll, of course, also be improving my diet. More whole foods, vegetables, especially green ones and iodized salt.

Will do lab work again in 6-8 weeks and see how things come up.


#25

Look for something better for when this product is used up.

Not impressed.
This is what a good product looks like, there are lots of products of this caliber:


amazon.com/Life-Extension-Multivitamin-Supplement-Capsules/dp/B075Z1LGTJ/ref=sr_1_3_s_it?s=hpc&ie=UTF8&qid=1522857467

Supplement Facts

Serving Size 2 tablets

Servings Per Container 60
Amount Per Serving

Vitamin A (as beta-carotene, acetate) (5,000 IU)

1500 mcg

Vitamin C (as ascorbic acid, calcium and niacinamide ascorbates)

500 mg

Vitamin D3 (as cholecalciferol) (2,000 IU)

50 mcg

Vitamin E (as D-alpha tocopheryl succinate, D-alpha tocopherol)

67 mg

Thiamine (vitamin B1) (as thiamine HCI)

75 mg

Riboflavin (vitamin B2) (as riboflavin, riboflavin 5’-phosphate)

50 mg

Niacin (as niacinamide, niacinamide ascorbate)

50 mg

Vitamin B6 (as pyridoxine HCI, pyridoxal 5’-phosphate)

75 mg

Folate (as L-5-methyltetrahydrofolate calcium salt)

400 mcg

Vitamin B12 (as methylcobalamin)

300 mcg

Biotin

300 mcg

Pantothenic acid (as D-calcium pantothenate)

50 mg

Iodine (as potassium iodide)

150 mcg

Magnesium (as magnesium oxide)

100 mg

Zinc (as zinc citrate, L-OptiZinc® zinc mono-L-methionine sulfate)

25 mg

Selenium [as sodium selenite, SelenoExcell® high selenium yeast, Se-methyl L-selenocysteine]

200 mcg

Manganese (as manganese citrate, gluconate)

2 mg

Chromium [as Crominex® 3+ chromium stabilized with Capros® amla extract (fruit), PrimaVie® Shilajit]

200 mcg

Molybdenum (as molybdenum amino acid chelate)

100 mcg

Inositol

50 mg

Alpha lipoic acid

25 mg

Natural mixed tocopherols (providing gamma, delta, alpha, beta)

20 mg

Marigold extract (flower) [std. to 5 mg trans-lutein, 155 mcg trans-zeaxanthin]

11.12 mg

Apigenin

5 mg

Boron (as boron amino acid chelate)

3 mg

Lycopene [from LycoBeads® natural tomato extract (fruit)]

1 mg

Other ingredients: stearic acid, croscarmellose sodium, vegetable stearate, silica, aqueous film coating (purified water, hydroxypropyl methylcellulose, glycerin), dicalcium phosphate, microcrystalline cellulose, maltodextrin.

Lycored Lycopene TM is a registered trademark of Lycored; Orange, New Jersey.
SelenoExcell® is a registered trademark of Cypress Systems Inc.
L-OptiZinc® is a registered trademark of InterHealth N.I.
Crominex® 3+, Capros® and PrimaVie® are registered trademarks of Natreon, Inc.
Dosage and Use

Take two (2) tablets daily in divided doses with meals, or as recommended by a healthcare practitioner.

#26

Oh but I hear that it is better to take vitamins/minerals separately instead of all of them together in a multivitamin because they often adversely affect absorption of each other and ultimately end up being useless.


#27

After @KSman 's post about Life Extension multivitamin, I’ve been researching different brands and not sure which one to take. I’m reading a lot of conflicting information - some say, you should take vitamins individually, instead of as a multivitamin, because vitamins and minerals in multi adversely affect absorption of each other.

But then it becomes too complicated to take so many vitamins pills separately. Can anyone here recommend a simplified vitamin supplemention regime?

It seems like I absolutely must get:

    • Iodine (for Thyroid)
    • Selenium (for Thyroid)
    • Vitamin D (deficient)
    • B 12 / Methyl Folate (deficient)
    • Zinc (for Testosterone)
    • Copper (for Testosterone)
    • Magnesium but only a little because when I take ZMA capsules, it upsets my stomach. But when I take only Zinc + Copper (Zinc Balance, Jarrow’s formula), it works fine.

Also, based on a lot of reading, I think, I should also take:

    • Krill / Fish Oil
    • Vitamin K2 (Mk4, mk7) and K1
    • CoQ10
    • Ashwagandha (adaptogenic)
    • Vitamin A
    • L-Tyrosine

Any recommendations?

Found this but Iodine is kinda low even after taking 3 pills and very expensive ($62!)
https://getkion.com/shop/essential-products/thorne-multi-vitamin-elite/


#28

My multi has the same 75mcg. I supplement that with a kelp pill which adds another 150mcg.


#29

You need to find out how to break down your food too because food contains many different nutrients. You are over-thinking this.

Do not take DHEA, Vit-D, Vit-E with high fiber foods, better with a meal with more fats/oils that will carry these through the gut wall.


#30

Been a week since I started levothyroxine and I am noticing increased hair loss / hair fall. I run my fingers in the shower and it comes out. I wake up and there is bunch scattered on my pillow.

I thought hair loss would stop when I start taking levothyroxine but it seems to be increasing. I have been having hair thinning for a year and a half already but seems to have sped up in last week. Plus dandruff, dry somewhat itchy scalp.

Is it that additional hormone is getting rid of weak thin hair to be replaced with thicker stronger hair and I just need to wait it out?

2nd negative - noticing skin dryness in last few days. Esp around ears and scalp.

I am taking 100mcg first thing in the morning 60-90 mins before eating. I am 72kg , 5’10 male

On the positive side - I think my mood is better and perhaps less mental fog.


#31

I wanted to share this. My research about supplements led me to NutraHacker. You can upload your DNA data (from 23andMe - which I’ve done) and it creates a personalized multi-vitamin for you BASED on your specific genetic predisposition. Here is what came for me below. For example, you’d see that it recommends Vitamin E in a different form for my specific genetic predisposition.

INGREDIENT
DOSAGE
Vitamin B6 (Pyridoxal-5’-Phosphate)
5 mg
Betaine
150 mg
Boron
1 mg
Chromium (Picolinate)
200 mcg
Fish Oil (Omega-3)
84 mg
Folate (5-Methyltetrahydrofolate)
400 mcg
Grape Seed Extract 95%
100 mg
Iodine
125 mcg
Magnesium (Glycinate)
180 mg
Manganese (Citrate)
3 mg
Molybdenum
75 mcg
NAC
70 mg
Phosphatidyl Serine
20 mg
Phosphatidylcholine
70 mg
Selenium
100 mcg
Theanine
75 mg
Vanadium
2 mg
Vitamin A (Retinyl Palmitate)
4000 IU
Vitamin B12 (Hydroxycobalamin)
100 mcg
Vitamin B2 (Riboflavin)
10 mg
Vitamin B3 (Niacin)
10 mg
Vitamin B5 (Pantethine)
15 mg
Vitamin C (Ascorbic Acid)
150 mg
Vitamin D3
2000 IU
Vitamin E (Tocotrienols)
9.5 mg
Vitamin K2 (MK7)
50 mcg
Zinc
20 mg

Anyway, I also wanted to re-ask my previous question:
Is it that additional hormone is getting rid of weak thin hair to be replaced with thicker stronger hair and I just need to wait it out?


#32

Hello @KSman @systemlord

Looking for advise on next-steps of treatment.

Hypothyroidism treatment:
-> Levthryoxine 100mcg ED morning for 2 weeks.
-> Increased dosage to 125mcg now (since yesterday).
-> Supplements (Iodine 150mcg, selenium, vitamin b, d3 etc.)
(Self-medicating as doctor told me I do not have hypothyroidism and I only need to treat hypogonadism)

Hypothyroidism self-treatment results:
-> Improved clarity of thought and energy but (on negative side) increased hair-fall. Perhaps weak hair is falling to make room for fresh new strong hair growth.

Thyroid - Questions:
Do I need to do anything else now? Or just continue with this dosage and re-test Thyroids (t4, t3, TSH, ft3, ft4, rt3) in few weeks?


Hypogonadism symptoms:
-> Worsening of ED. Even with Cialis 20mg (a few times over last week - normally, I used to take only 5mg). Unable to maintain erection. Takes a very long time to ejaculate. And semen volume is barely a drop.

-> slowed down facial hair growth 2 days to grow same amount of beard as I normally grew by evening the same day!

-> Overall mood, energy, libido, aggression not returned to levels of even 1 year ago. And 1 year ago, my T was already quite low (360s)

Hypogonadism/Testosterone Questions:
What should be my next step of treatment/lab work for low T/hypogonadism/ED? I really do not want to go on TRT unless absolutely necessary. I’d like to identify root cause and if it is fixable, fix that.
1 -> Doppler Sonography found Grade 2 Varicole (varicose veins) in testes. Should I get a microscopic surgery for it?

2 -> What else can I try before going on TRT? Do I need to try simple HCG monotherapy before going on TRT? Or do I need to try Nolvodex or Clomid? I’ve never taken any steroids, my testicles are normal sized. So, this is not a result of some steroid induced shut-down. If so, how long to do monotherapy or nolvodex/clomid?

@KSman wrote:

Vein problems in your testes does not explain why LH/FSH is low. You appear to have secondary hypogonadism and that is not explained by high E2 or high prolactin and thus not correctable by lowering those.

Being secondary means - no other solution than TRT?

Also, my E2 is already low. If I took Nolvadex or Clomid (should I?) to increase LH and FSH, will my E2 get even lower? For libido, I think E2 needs to be increased to about 22. And of course, T needs to increase from 140 to even 400s. I remember I had decent erections when my T was about 360 even.


#33

Hello Everyone - here are updated results. Mixed bag! Good news, bad news. Looking for guidance for next steps:

Hypothyroidism:
After (self-medicating) Levothyroxine 125 mcg for 6 weeks, my new results are:

  • TRI-IODO THYRONIN, (T3): 100.48 [60.0 - 181.0 ng/dL]
  • FREE T3: 3.93 [1.50 - 3.91]
  • THYROXIN, (T4): 8.70 [3.20 - 12.6 µg/dL]
  • FREE T4: 1.75 [0.89 - 1.76 ng/dL]
  • THYROID STIMULATING HORMONE (TSH) <0.01 [Low 0.35 - 5.50 µIU/mL]

Seems like I should continue Levothyroxine 125 mcg? Correct or would you recommend further tests to identify root cause? Already ruled out auto-immune disease as anti-bodies were negative.

Hypogonadism:
Also been taking Nolvadex EOD for 4 weeks. My T has risen up significantly (although I don’t feel much different, and still have problem with erections).

  • CORTISOL MORNING, SERUM: 15.0 [3.7 - 19.4 µg/dL]
  • LUTEINIZING HORMONE: 6.44 [1.5 - 9.3 mIU/mL]
  • FSH: 3.75 [1.4 - 18.1 mIU/mL]
  • ESTRADIOL (E2): 41.7 [Males:- 0-39.8]
  • PROLACTIN: 23.34 [2.1 - 17.7 ng/mL]
  • TESTOSTERONE TOTAL: 417.73 [21.0 - 827.0 ng/dL]*

Seems like it is NOT Primary hypogonadism as T did increase after taking Nolvadex. Actually, perhaps, it increased because of Thyroid improvement? So, is it secondary hypogonadism?

If so, do I need to get MRI etc done for pituitary gland? Do I need to be on TRT or should I stay on Clomid/Nolvadex?

Request advise/suggestion for next steps.


#34

Estrogen can inhibit LH secretion on pituitary function, prolactin can also do the same. You need to get prolactin and estrogen undercontrol to see if testosterone level improve before committing to TRT. Elevated prolactin can cause sexual dysfunction.

Estrogen and prolactin make it look like primary hypogonadism, higher LH and lower testosterone. Hyperthyroidism can also cause sexual dysfunction.

Where are SHBG labs?


#35

They didn’t test for SHBG.

How can it be primary if T increased with Nolvadex/Clomid? I thought E2 and Prolactin were going to increase anyway because I took Nolvadex but did not take any AI.

Hypothyroidism - is fixed with Levothyroxine 125mcg, I suppose. Are you saying now I’ve hyperthyroidism? If so, do I need to lower my Levothyroxine dosage?