T Nation

Ksman & Others, Should I Start TRT?


KSMan and other experts, i cannot express how grateful i would be if you would provide me TRT advice.

I went to the doc about 3 months ago because of anxiety/depression and low energy/motivation. He ordered some blood tests and after reviewing the results diagnosed me with hypogonadism. As indicated below my dhea-s is really high too

-age 44
-height 5'10'
-waist 33-weight 170
-body and facial hair: lean, muscular, athletic. facial hair normal to high
-describe where you carry fat and how changed: stomach (but minimal)
-health conditions, symptoms since puberty. low energy/motivation.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: no
-describe diet: very healthy diet. Many fruits
and veggies and white meat.
-describe training: alternate between cardio and weight training about 5 days per week
-testes ache, ever, with a fever? no
-how have morning wood and nocturnal erections changed: morning wood maybe 3 times per week

LAB RESULTS (On 8/10/2013...TAKEN AT NOON...12 Hours Fasting)
TT: 204 (300 to 890)
Testosterone Bioavailable: 138.8 ng/dl (130 to 680)
Testosterone Free: 48.8 pg/ml (47.0 to 244)
PSA 1.51 ng/mL (0.00 - 2.50)
Prolactine, Serum: 4.2 ng/mL (2.1 - 17.7)
shbh:23 nmol/L (11 to 80)
FSH: 6.1 mIU/mL (1.4 - 18.1)
LH Level: 6.1 mIU/mL (males 20-70 yrs 1.5 - 9.3 mIU/mL)
Thyroxine Free: 0.85 ng/dL (0.76 - 1.46)
Cortisol Random: 11.4 mcg/dL (before 10 am 3.7 - 19.4 after 5 pm 2.9 to 17.3)

LAB RESULTS (On 8/30/2013...TAKEN AT 5:00 PM...NOT Fasting)
Dhea-s 490.7 ug/dL 44.3 - 331.0
Estradiol 16.8 pg/mL 7.6 - 42.6
TSH 2.950 uIU/mL 0.450 - 4.500
Throxine T4 7.6 ug/dL 4.5 - 12.0
Triiodothvromine T3 97 ng/dL 71 - 180

Should I start TRT? If so what protocol?

Thank you so much for your help!!


T4 and T3 should be mid scale, 8.25 and 12.5.
Both are low and TSH is high.
Please read the thyroid basics sticky.

  • post oral waking and mid afternoon body temperatures
  • what is your history of using iodized salt and vitamins that list iodine? Concern is iodine deficiency.

You are expected to not be able to absorb transdermal T drugs, - gels and creams. So you would need to inject. Docs do not know that.

Please read the protocol for injections sticky and advice for new guys if not already.

You appear to have primary hypogonadism. We know that this is not a result of low DHEA.

So that is quite clear cut VS diagnosing secondary and your thyroid problem is then not connected.

So you need TRT, probably must inject and need to resolve your thyroid issues. Thyroid problems could be from iodine deficiency. You need more labs

You need to test fT3, fT4 as this is really what counts. Might be a good idea to test for thyroid antibodies. Do not do these labs after doc palpates your thyroid, wait a few days. And doc should have checked your thyroid for size, symmetry, smooth VS lumps etc.

Get the iodine intake info posted and get the body temperatures.

Need time of day for the cortisol lab. Really need “AM cortisol” and do that at 8AM. Add time of day to your labs, use the [edit] in the corner of your post.


KSMan, thanks much for your response. I can’t believe you are providing this level of expertise for free…

–I have updated my original post with Lab times as you requested.
–Have read stickies but will read again.
–Will post oral waking and mid-afternoon body temperatures soon.
–I have never supplemented iodized salt in any form. I take MonaVie (blend of 19 dark fruit juices…very high in antioxidants) and Juice Plus (whole vegetable/fruit capsules) but none of them list Iodine as being present.
–I have been prescribed HCG, AI and injectable Test-C but have not yet began taking (waiting for guidance…I think I will start today since you gave me the TRT go-ahead)
–Will get fT3 and fT4 labs next week and report back
–Will ask Doc to check my thyroid size, symmetry, smooth VS lumps



KSMan, well in response to your request I took my temps (actually had to go to cvs yesterday to buy a thermometer…BACHELORS!). Here they are:
–Morning: 97.7
–Mid-afternoon: 97.5

by the way, morning was literally right out of bed…I wonder if i was perhaps still a little warm from the blankets but hopefully that doesn’t skew it.

I am going to schedule the labs you advised tomorrow.

Again thanks so much for your help!


When doc checks your thyroid, do not do thyroid labs soon after as palpation can release hormones. Some people can see and feel thyroid issues.

You really do seem to be hypo!

Cortisol levels typically drop by mid day, so perhaps your result is good.

Thyroid levels affect every cell and function in your body. If you can get thyroid situation sorted out, other systems might self-correct to some extent.

Societies introduced iodized salt to avoid the nasty problems of iodine deficiency. Now the lessons are forgotten.

Note that humans store 1.0 - 1.5 GRAMS of iodine, mostly in the thyroid. Iodine is so important that evolution has favoured iodine hording. If you do an IR of .75 GRAMS, that is 5000 RDA’s of 15 micro grams. So you can see that the RDA will not recover iodine levels, it will only b e treading water.

Women store more iodine in men; in their breast tissue. There is a obvious Darwinian advantage of delivering iodine to nursing babies.


Thanks ksman! I will have doc check my thyroid
as u suggested…I already ordered some iodoral
after reading ur thyroid sticky. It should be here tomorrow.
by the way my mom had thyroid issues and my sister
had hers removed! I work in ahigh stress job (engineer)
And I eat out almost every night.

Question: when u said above if I get my thyroid issue
resolved my other systems may self-correct, u r not
Saying I should not begin trt are u? I dont think
u r because u seemed to be very clear before
that I should benefit from trt…but I want to
make sure…thanks again!!!