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Low LH, Low FSH, Low Test & Low SHBG. Nebido Making Things Worse

  • FYI I’m posting this for a good friend of mine who has been struggling with his health for some time. I offered to post this becuase he is really not doing well and needs some help. I hope that’s okay?

He has been having severe low t/thyroid symptoms for years and has seen a number of doctors over the years who from what I have heard are making things worse. Mainly due to their lack of knowledge of male hormones. At present they have him on Nebido and not monitoring or medicating for E2.

Here are his details…

Age: 55
Height: 6’
Waist: 38/40
Weight: 100kg (22lbs)

Body is on the “solid” side, reasonably muscular even though i dont work out

Facial hair - lots of it and it grows quickly

Carry fat around my middle, it has increased significantly in last couple of years but i put that down to too much wine/beer

History.
Had glandular fever in my teens. Always been relatively low on energy and had long standing problems with concentration/brain fog. Would say i always had a relatively low sex drive. Have suffered several episodes of high anxiety which resulted in anti-depressants. In recent years had a tendancy to mild depression as well. Diagnosed with CFS and get exhausted by 2 hours of mental exertion (working, concentrating, talking with people). Mental fatigue is worse than actual physical fatigue, can still ski for a few hours a day. Often feel very light-headed and can become irritable easily.

Diagnosed by an endo with

  • Hypogonadotrophic hypogonadism
  • Borderline secondary hypothyroidism
  • Post viral fatigue syndrome (Epstein Barr virus)
  • Multi nodular thyroid goitre (no suspicious features)

Short synacthen test suggested abnormal adrenal function but a test of Hydrocortisone didnt make me feel any different

Had an MRI of my pituitary but it came back fine

Alcohol; yes, drink wine pretty much every day (bizzarely it gives me energy!) and occasional beer

Dont do any drugs

No hair loss

Diet is pretty good - generally high fat low carb. Lots of veg, good fats, meat/fish. Avoid wheat & gluten

Dont do any training other than walking

Testes are fine, no fever

Before taking nebido had no morning wood or night time erections now i have plenty, however fatigue plus the negative effects of anti-depressants have more of a negative effect on libido than any benefits from injections.

  1. Take nebido every 10/11 weeks - normal does of 1000mg/4ml
  2. 150mcg Thyroxine (also been suggested to try T3)
  3. Started testo gel approx Mar 2015 and switched to Nebido in May 2015
    Started Thyroxine Jul 2015 on around 50mcg and built up to current does of 150mcg
  4. Dabbled with 5 mcg of T3 twice a day but didnt notice anything

Bloods.

Full Bloods:

https://docs.google.com/spreadsheets/d/1yQkhFk6KL31DbSKZ_IrkVkCXTtTrEnMttp0th-cbgUU

Thanks.

Your friend doesn’t convert fT4 -> fT3 well at all, fT4 is high and fT3 is low normal. Imagine having a full tank of gas and not getting enough fuel to the engine, it doesn’t run well. He is under medicated.

Post the labs. Labs should not show personal name etc. Link need a password.

fT3 is the only active thyroid hormone, there is no receptor for T4.

See below re using oral body temperatures to eval overall thyroid function. Body temps can be used to adjust thyroid med dosing.

Thyroid function has a huge effect on energy and weight gain/loss.

Solid build? I worry about insulin resistance and diabetes.

Stop testing LH/FSH!

Need TT, FT and E2

Thyroid under medicated. Goal is fT3 at midrange or a bit higher.
Ignore TSH and fT4

Labs:
TT
FT
E2
CBC
hematocrit
AM cortisol
IGF-1 to eval GH status. Do not test GH directly
DHEA-S - at this age, just get 25mg DHEA and test later

Supplements:
high potency B-complex with 150mcg iodine 200 mg selenium
fish oil
ZMA - see Biotest store at bed time or split day/night
Vit-C 1000mg at bed time.
Natural source Vit-E
Iodizes salt still a good idea.

Goiter from not using iodized salt for years?
Nodules at risk of cancer, TSH–>zero helpful.
Selenium also important.

nebido: Levels unsteady and E2 management cannot be done right. Switch to 50mg T subq twice a week and take 1/2mg anastrozole at time of injections.

E2 management is very important for prostate health. So is ejaculation to clear seminal vessels - otherwise can be inflamed and inflammation affects prostate.


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

  • 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.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Agreed, that’s what it looks like.

Thanks for the info Ksman… I’ve commented and added any questions below each of your comments -

Post the labs. Labs should not show personal name etc. Link need a password.

- Sorry thought the link worked. Screenshot of bloods has most results anyhow.

fT3 is the only active thyroid hormone, there is no receptor for T4.

-Yes looks like he’s not converting FT4 to FT3 very well as Systemlord said.

See below re using oral body temperatures to eval overall thyroid function. Body temps can be used to adjust thyroid med dosing.

- I have already told him to start taking temps morning and afternoon. And tips on managing thyroid med dosing using body temps as guidance?

Thyroid function has a huge effect on energy and weight gain/loss.

- Will pass on this Info.

Solid build? I worry about insulin resistance and diabetes.

- Will pass on this Info.

Stop testing LH/FSH!

- Yes already told him this is a waste of time. His endo is clueless.

Need TT, FT and E2

- I already told him this is what he needs to test. But I assume one of the issues he will have is getting an reliable reading on E2 because he is on Nebido. (Big ups and downs etc)

Thyroid under medicated. Goal is fT3 at midrange or a bit higher.

- Any view on medication options? If he’s having issues converting FT4 to FT3 would a good option be to take just T3?

Ignore TSH and fT4

- Will pass on this Info.

Labs:
TT
FT
E2
CBC
hematocrit
AM cortisol
IGF-1 to eval GH status. Do not test GH directly
DHEA-S - at this age, just get 25mg DHEA and test later

- Okay will suggest he gets these labs done. Just to clarify, are you saying to get DHEA-S tested first or start taking DHEA first? Also would getting FT3 be worth getting tested as a baseline before changing thyroid meds?

Supplements:
high potency B-complex with 150mcg iodine 200 mg selenium
fish oil
ZMA - see Biotest store at bed time or split day/night
Vit-C 1000mg at bed time.
Natural source Vit-E
Iodizes salt still a good idea.

- Will pass on this Info

Goiter from not using iodized salt for years?

- Could be, will ask him.

Nodules at risk of cancer, TSH–>zero helpful.
Selenium also important.

- Will pass on this Info.

nebido: Levels unsteady and E2 management cannot be done right. Switch to 50mg T subq twice a week and take 1/2mg anastrozole at time of injections.

- I already suggested he did this but wondering how best to switch? He just had a Nebido shot last week so won’t be due one for another 9 weeks. I assume he should wait till his next shot is due and start from there? But in the mean time would you recommend getting E2 tested and then start taking AI? Would have thought he would have high E2 and that would be making him feel crap.

E2 management is very important for prostate health. So is ejaculation to clear seminal vessels - otherwise can be inflamed and inflammation affects prostate.

- Will pass on this Info