T Nation

Low T, Seemingly High TSH - 30 YO Help Needed


#1

30 Year Old Male

Height: 5’11"
Weight: 230
BF%: ~20

My low T journey began when I requested my GP check for Testosterone and Thyroid values during an annual checkup. My reasoning for the request was that I had been dealing with a few worrying issues: low libido, weak erections, mental fogginess, and short-term memory issues. For several months had been convincing myself I was just overworked or stressed (in reality, I don’t feel I was either of these things). 2 weeks prior to the appointment I had started taking a Forskolin supplement and was surprised how much it seemed to help my strength and fatloss. I was curious what my blood looked like given my symptoms and effectiveness of the supplement.

Libido / Sex
Libido is low, I can recognize sexy women but the desire to play with them is low. Erections are weak and only sustainable with fast thrusting and in certain positions. Morning wood is non-existent.

Body & Scalp Hair:
I feel that my scalp hair has been thinning progressively over the past couple of years, but has recently reached a point of being noticeable to friends & family. It appears to be thinning evenly all over, not exclusively in the MPB vertex area. In recent months the outer hair of my eyebrows has been falling out, and although I have a sizable beard I feel it has thinned as well. Otherwise, my body hair has always been about average.

Stress & Lifestyle:
I work in Tech as a engineer. Specifically I work in R&D and sometimes have to be up at odd hours communicating with co-workers in other parts of the world. Generally speaking though, I find my job manageable. In the past I would get maybe 6HRs of sleep a night, but for the past year I have made it a priority to get a solid 8 without interruption.

Fat Storage:
My body prefers to store fat in the centrally in the abdominal area. I store very little fat elsewhere, and this has been the trend my whole life. Over the years I have been in the 15-20% BF range, depending if I was bulking or dieting… but I have never been out totally out of shape or sedentary… I’ve played sports and lifted my whole life.

Cycle History:
Very tame, and nothing in the past 5 years. In earlier days I did three runs of 500mg of Test E for 12 weeks with some Deca thrown in. Post-Cycle I used a combo of Nolva + Clomid for 30-45 days, and always felt refreshed at the end but never did any post-cycle bloodwork (because I felt fine). I only did a few cycles because I always had really great strength naturally and decided I was satisfied with that.

Initial Blood Work 3/1 (With GP) Note - I was taking Forskolin during this time

TT: 320 (250 - 827)
Vitamin D3: 26 (> 30)
TSH: 4.48 (.5 - 4.5)

I had a metabolic panel done as well and all of those values were in range. I tried to raise the issue of low Testosterone and Thyroid with my GP but she is an idiot and claimed those values were ‘perfectly good’. Realizing I was dealing with an incompetent person I took it upon myself to book appointments with a Urologist and Endocrinologist… at the time of this post I have only seen the Urologist so far, and my experience there follows below.

Blood work 4/1 (With Urologist) Note - I had discontinued Forskolin 12 days prior

TT: (194) ( 250-827)
Free Test: Unmeasurable
FSH: 1.4 (1.6 - 8.0)
LH: 2.7 (1.5 - 9.3)
Prolactin: 8.8 (2.0 - 18.0)
Estradiol: 24 (< 39)
SHBG: 17 (10-50)
Albumin: 4.7 (3.6 - 5.1)

Following this bloodwork my Urologist diagnosed me as hypogonadal. His claim was that I am ‘primary’ because my testicles are a very healthy size and my bloodwork is normal aside from the Total Test. My question for you all though, is don’t my LH and FSH seem low? Also, the fact that my TT was higher on the first bloodwork while I was taking Forskolin (which stimulates LH) seems to imply that my testicles can respond to greater LH signals by producing more Testosterone (although still sub normal levels). I tried to ask him about Clomid to restart my system, but he disagreed it would be effective and started me on Test Cyp injections instead… 200MG bi-weekly. I am aware that the frequency there is not ideal, so I plan to take 100mg a week and see how my blood work looks. Still, I am only 30 and would prefer to restore my natural testosterone production rather than rely on pinning myself.

Also, that TSH value from my first set of blood work makes me question if my Testosterone issues are being caused by Hypothyroidism. I have an appointment with an Endocrinologist in a week, and will update you all with the results soon. I’m going to ask them about Cortisol and a full Thryroid panel blood test as well.

I have the following daily supplement regime, only recent addition is the Vitamin D after first set of lab results:

8G FishOil Caps
6000 IU Vit D3
COQ10 (300mg 2x)
Multi-Vitamin
Zinc 25mg before bed
Magnesium (400mg)
Creatine 5g x2 (am/evening)

Your collective insight is greatly appreciated!


#2

Your testes work fine, that means you are not primary. LH/FSH is low, you are secondary.

TSH is a concern. KSman will be able to elaborate more.


#3

Thanks Equalo212 very much for the reply and confirming my suspicions about LH/FSH. It has been a nightmare dealing with these doctors and I was so happy to find this forum.

At my age with secondary, do you think I should push my Urologist for Clomid to attempt a HPTA restart? I tried to bring it up today, but he seemed clueless about it… perhaps if I printed out some studies for him.

Regarding TSH, is it possible that my Forskolin supplement could inflate this number? The only prior Thyroid TSH test I have is from 3 years ago and it was 2.1 at the time (and I did not have any symptoms back then). I’ve read some of KSMan’s posts on Iodine supplementation but didn’t want to start down that path without some input on these numbers first. Hopefully a full Thyroid panel will reveal more in the coming weeks.


#4

You do have a better understanding of these things than those docs.

Thyroid:
Have you always been using iodized salt?
Get cold easier now?
Hair loss - yes
Eyebrows thin? - yes
Dry skin?
Thyroid enlarged, asymmetrical, lump or sore?
Vitamins contain iodine and selenium? - for how long?

Please follow these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics explained - post your oral body temperatures
  • finding a TRT doc
  • HPTA restart

Your FT is low, so FT–>E2 is probably low which suggests that your body is not clearing estrogens effectively. That focuses on the liver or perhaps adverse gut bacteria converts E metabolites back to active forms that are reabsorbed. Probiotics then may be useful.

Labs, please post with ranges. You have some now
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
AST/ALT
DHEA-S
fasting cholesterol
fasting glucose


#5

Thanks KSman, I was hoping you’d stop by :slight_smile:

Thyroid:
Have you always been using iodized salt? - I’ve avoided all salts in recent years because my blood pressure was approaching the higher end of normal (125/75) and I was worried high sodium intake would worsen it.
Get cold easier now? - More often than not I feel ‘too hot’ rather than cold, I prefer to have the AC on at home and in the car, but I realize feeling warm can be different from actually being warm… I will get a thermometer and begin recording temps.
Hair loss - yes
Eyebrows thin? - yes
Dry skin? - yes
Thyroid enlarged, asymmetrical, lump or sore? – As far as I can tell, it doesn’t seem lumpy or sore.
Vitamins contain iodine and selenium? - for how long? I use a multi-vitamin from Costco that has Iodine 150mcg and Selenium 55mcg. I’ve been using this for several years now.

Blood
hematocrit - 46.2 (38-50)
AST/ALT - AST = 38 (10-40), ALT= 46 (9-46) << note I take creatine and lifted heavy the night before, which I was told could inflate these numbers.
DHEA-S - N/A will request
fasting cholesterol - 176 (125-200) total, HDL - 39 (> 40), LDL - 110 (<130)
fasting glucose - 90 (65-99)

I will get a thermometer and begin tracking waking and afternoon body temps. So far I have two recorded afternoon temps from the Dr’s office:
(3/1) 98.2
(4/1) 98.2

@KSman I ordered some Iodoral from Amazon, should I try taking that for Iodine supplementation? Is there a risk of Iodine supplementation inducing further hypothyroidism or goiter? From my research it seems like too much can be as risky as too little – what’s your take?


#6

Problems with iodine supplementation are activation of an existing problem or inflammation resulting from selenium deficiency.

Blood pressure:
Salt does not cause the problem, but reducing blood volume helps and less salt helps. But then you get iodine deficiency. 150mcg in your vitamins could easily be insufficient. You are getting lots of Vit-D3 which is good. At your age, DHEA-S levels are probably good.


#7

@KSman would you recommend dosing daily 12.5mg of Iodine and 200mcg of Selenium as a good starting point?

Edit: One other thing I wanted to throw out there, 2 years ago I moved to an area with fluoridated tap-water. I have read that fluoride can impact the thyroid negatively, possibly through disrupting iodine levels. Not to sound like a conspiracy theorist, but I thought I would mention it. I’ve switched to bottled water now for all purposes, just to be safe.


#8

Anyone input on the proposed Iodine & Selenium doses? @KSman? I could break the Iodoral tabs in half if 12.5 is too aggressive to start…

Logs of recent temps, taken upon waking and in late afternoon:

AM - 97.4, PM - 98.3
AM - 97.2, PM - 98.4
AM - 97.3, PM - 98.2


#9

Update — I saw an endocrinologist to investigate the possible Thyroid angle of my low Testosterone situation. He seemed dismissive of my Thyroid being an issue, because ‘TSH of 4.5 is still fairly normal’, but agreed to do full Thyroid panel blood work to get a clearer picture of the situation. He also ordered an MRI of my pituitary gland to rule out any tumors.

I’ll report back once I have the results of these tests.

Any thoughts / recommendations in the meantime are always welcome!


#10

Floride levels in floridated water are typically not a problem.
Bromines seem to be a larger issue as these are in some citrus sport drinks, but getting phased out. Also as a dough conditioner in commercially produded bread. Oddly, idine was used for that, but some docs said that the iodine might be dangeous, so now it bromine and the doctors are silent.

Do not use reverse osmosis water for drinking, you need the minerals.


#11

@KSman need your input

I started the Iodine IR with Iodoral, 12.5mg a day. I have now noticed two things… I seem to have more energy, I am experiencing discomfort in the area where my kidneys are. I’m on day three. I noticed when I skipped the Iodoral dose I did not have the pain in that area.

FYI my bloodwork has never indicated any kidney issues, and I haven’t felt this sensation before…

Could the iodine be stressing my kidneys? Is it a detox effect?

Please advise!


#12

Iodine can kill your intestinal flora. I’d take a gas pill and see if that resolves your pain.


#13

I will try having some Yogurt, as I believe that is a natural pro-biotic.

I tried taking 6mg vs 12mg today, still had the pain, although slightly less intense. I think I may stop for now, I’m worried it could be damaging tissue somewhere.

Aside from the pain, I am noticing that I go from mentally foggy to hyper alert… almost too alert… as if my mind is racing. It’s one extreme to the other.

Ultimately, I don’t know if I have Hashimoto’s (still waiting on bloodwork), so maybe best to sit tight till I figure that out first. I have heard Iodine can actually make things worse for people with Hashimoto’s…

sigh


#14

Interesting and encouraging result.
Are you getting selenium too?

Digestive effects do look like a good guess. But not expected with 12mg.


#15

So I halted my Iodine (Iodoral) experiment while I waited to receive full Thyroid panel results, as I didn’t want to just be super dosing Iodine while guessing that I was deficient.

I have continued to take 200mcg Selenium daily though.

Just got the following results from the Endo:

Pituitary MRI: Normal, no tumors or abnormalities detected

IGF-1 (LC/MS): 269 ng/mL (53-331)
Vitamin D25-OH: 72ng/mL (30-100)
Testosterone Free: 199 pg/mL (35 - 155)
Testosterone Total: 667 ng/mL (250 - 1100)
Ferritin: 144 ng/ mL (20-345)
FSH: < 0.7 (1.6 - 8.0)
LH: < 0.2 (1.5 - 9.3 mIU/mL)
Thyroid Peroxidase Antibodies: 1 ( < 9 IU/mL)
Hematocrit: 43.9% (38 - 50 %)
Prolactin: 6.9 ng/mL ( 2.0 - 18.0)
Iron: 84mcg/dL (50-180)

T3 Total: 86 (76-181)
T4 Free: 1.0 (0.8 - 1.8)
TSH: 1.4 (0.4 - 4.5)

Metabolic panel was totally normal – no kidney, liver, or diabetic issues.

Now, what really jumped out at me here is that my Thyroid TSH went from 4.5 to 1.4. The two consistent changes I have done during that time (2 months) is bring my Vitamin D3 levels up from 26 to 70 … and go on HRT (100mg / week). The Iodoral and Selenium I actually started AFTER I had this blood drawn, but before I got the results, so we can’t really say they are a part of this blood snapshot.

Could either of those things explain a TSH going from 4.5 to 1.4? How do the other Thyroid markers look?


#16

See like to see TSH closer to 1.0 and T3, T4, fT3 fT4 should be close to mid range. Your T3 and fT3 are low. Keep track of your body temperatures and note if you start to feel more alert.

Vit-D25 very good.

TT could be better, but may be an effect of lower SHBG.

Hematocrit is low for those T levels and lower than pre-TRT.
Have you donated blood?
Suggest an occult blood test to look for evidence of a blood loss via GI bleed. Simple poop smear test. Must point out that ferritin and iron do not indicate a GI bleed. RBC should be strong with TRT.

How long were you on TRT for this lab work?

Missing lab work:
E2

No need to do these again: LH/FSH, prolactin

What was exact lab timing relative to injections?


#17

@KSman KSMan I will try resuming the Iodoral IR regiment, now that it appears I do not have Hashimoto’s. Perhaps that will help get my TSH from 1.4 to 1.0 territory. I’ll continue dosing Selenium 200mcg.

Any thoughts on that TSH change from 4.5 to 1.4 though? It seems a pretty drastic reversal, could the TRT have caused that?

For this latest lab work I had been on TRT for 3 weeks.

I injected 100mg Test Cyp on a Monday and had the blood pulled on a Friday, so ~4 days or so with the lab timing.

I haven’t donated blood recently but because I am seeing two diff doctors (urologist, endo) they have each been ordering many tests, so leading up to this latest batch of blood work I had already given 12+ vials of blood that week… maybe it impacted the Hematocrit? RBC was 5.08 (ref, 4.2 - 5.8) for this latest labwork.

I really want to know my E2 now that I have started TRT… I have a lot of muscle mass but my bodyfat is 20% so I am worried about T >> E conversion. I have some Arimidex ordered from ADC since my doctors have been dragging their heels on it.


#18

Biweekly dosing will help reduce T->E2.

I’m also around 20% BF and yes, my E2 increased to an intolerable level. Working on the BF levels at the moment.

Do you have any symptoms?


#19

The big drop in TSH is interesting, but we do not know what that means.

Note that larger doses of iodine cause high TSH levels, a natural reflex. TSH labs are then misleading at best and you should be down to a maintenance dose for a few?several weeks before TSH labs are useful.


#20

@gonadthebarbarian

I suspect an E2 increase because my first two weeks of TRT were amazing… tons of energy, positive mental state, rock hard erections, etc. Now… things are still better than they were prior to starting the TRT, but I feel a bit more emotional and my downstairs equipment isn’t quite as solid. Worried my body started converting that rise in T to E2.

I have been taking 50mg of Zinc Gluconate before bed to try and help with that while I wait for my Arimidex to arrive. What are you using now?

I’m working on the bodyfat % as well, just trying to do so gradually as I am a powerlifter and don’t want to ruin my strength.