Low T, Tyroid Issues...Start with What?

Hi All
I found this site a while ago and firstly I want to thank everybody who contributes here, making this site a great source of information for people in need.
Introduction;
-Age 46
-Height 6.0
-Waist 38
-Weight 192 lbs
-Describe body and facial hair I have hair on the arm,legs ,beard though I start to loose some hair on the head
-Describe where you carry fat and how changed mostly on the belly (can’t get rid of )
-Health conditions, symptoms [history] exercise induced asthma,enlarged prostate,always feel cold
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever oil fish,Vitamin D3,Zn 50 mg,Potassium 99 mg on daily basis,Albuterol inhaler as needed only
-Lab results with ranges:See bellow I put them along my case
-Describe diet [some create substantial damage with starvation diets]-never fast food,cut on wheat,pasta,pops-I drink a lot of milk and have a lot of no fat yogurt (might be not the best for me)
-Describe training I ride my bicycle about one hour a day-I am crazy about it though my strength is not there at all I have endurance but no strength
-Testes ache, ever, with a fever No pain or any discomfort in a separate note I pee sometimes 5 times a night
-How have morning wood and nocturnal erections changed once in a while I have morning wood .low libido though.
Now the story:

July 2012 one day I had a scary amount of blood in my urine (basically I was peeing blood).Two days after that I was seen by an urologist who initiated his protocol for such a situation CT scan, some BW and a cystoscopy evaluation plus a DRE which he claimed was all right (CT scan revealed my prostate was prominent size â??)I insisted to have the T tested as well (remember not so much strength ?)
July 2012 BW came back as follows:
Testosterone 208 ng/dL (280-800)
SHBG 21 nmol/L (10-80)
Free test calc 12.3 pg/mL ( 12-25)
PSA 1.43 ng/mL (0.03-4)
Cholesterol 223 mg/dL (70-199)
HDL 56 mg/dL (40-90)
LDL 144 calculated mg/dL (50-129)
Triglicerydes 117 mg/dL (30-149)
Also to rule out cancer he run a fish test that came negative(it was OK he said)
Based on those results without any explanations or directions he put me on Androgel 1.62% two pumps a day and a follow up visit in 4 months .
Being completely uneducated into this, I trusted him and started the gel .
I felt extremely good-energy,strength,sex,sharp mind.In the meantime I tried to educate myself and I understood the wonder was not there to last and I cold turkey stopped the gel
.I let the system to clear up and I ordered myself a hormone panel that came back as follows
September 2012
Testosterone serum 255 ng/dL (348-1197)
Free testosterone direct 5,8 pg/mL (6.8-21.5)
FSH 2.5 mIU/mL (1.7-8.7)
LH 2.9 mIU/Ml (1.5-12.4)
DHEA S 240 ug/dL (88.9-427)
Estradiol 18.4 pg/mL (7.6-42.6)
TSH 5.2 uIU/mL (7.6-42.6)
Insulin 96.4 Uiu/mL (2.6-24.9)
HA1c 6.0 % (4.8-6.0)
Seeing that insulin #, I tried to be more diligent with my diet while continuing to ride my bike
While looking for a doctor this January 2013 I run myself another blood work (Surprises at least for me !)
January 2013
Cholesterol 240 mg/dL (50-200 )
Triglycerides 187 mg/dL (0-150)
HDL 50 mg/dL (40-61)
LDL 160 mg/dL (0-99)
TSH 7.78 Uiu/mL (0.45-4.5)
Tyroxine (T4) 6.3 ug/dL (4.5-12.0)
T3 Uptake 34 % (24-39)
Free Tyroxine Index 2.1 (1.2-4.9)
RBC 6.07 X10e6/uL (4.14-5.8)
Hematocrit 47.9 % (37.5-51)
AST (SGOT) 26 U/L ( 15-37)
ALT (SGPT) 74 U/L (30-65)
GGT 66 IU/L ( 0-65)
Glucose serum 97 mg/dL (74-106)
H1Ac 5,7 % (4.8-5.6)
Insulin 10.4 Uiu/mL (2.6-24.9)

So in about three months I see an increase in TSH ,cholesterol,tryglicerides,a significant drop in insulin.My body temp (oral) is average 96.8 at 7am / 97.7 at noon / 97.8 at 9 pm and I always feel cold as ever felt

Now what shall I start with ?
Start iodoral and check the temps .till I see the new doctor? Shall I wait to get a baseline?(I hope I will have full hormonal panels this time

But mostly what do you guys think my case is about-? How bad is it ?
Thank you for your time !
(I forgot to complain about some brain fog ,some mild memory issues I am doing now )
Respect

You are in full blown hypothyroidism. Find a thyroid specialist with good experience. Compounding pharmacies can refer you to a doc who prescribes porcine thyroid. You need a full study to rule out other possibilities.

Thyroglobulin Antibodies
Thyroglobulin
TPO Antibodies
Free T3
Free T4
TSH
Thyroid ultrasound

People with thyroid issues wont absorb gels. Read the injection stickies.

You were pre diabetic and your diet and exercise seems to have helped.
Successfully correcting your T will help contribute to lower your risk.
ALT looks a bit high, not sure what to make of it.
Your SBGH and E2 look good. A little bit E2 dominant with low T though.

A few more test you could run is vitamin D, IGF1, and, cortisol/acth.

Your thyroid though needs immediate attention and probably should be corrected before starting TRT since that can aggravate your symptoms.

Good luck

Nice to see temperature data from the get go. Speaking of iodine, what has your history been of iodine in vitamins and use of iodized salt? ??

If you have an iodine deficiency, other family members probably share this. Check body temps of others in the household. ??

Your high TSH and low T4 suggests that low iodine might be factor. But your case is quite severe, so things are probably lot that simple.

Doc palpated your thyroid?
Does your neck appear thick around your larynx?
Can you feel any lumps? Asymmetric?
Any odd feeling when you swallow?

Blood in urine: Did you gave a CT scan for kidney stones? ??

HDL was better before, now less. You can improve this. These are general points, some you have covered now.

  • fish oil, nuts, flax seed meal or oil
  • healthy fats such as olive oil

What has been happening with blood pressure? [BP] ??

Cortisol should be an AM lab draw.

Do not do thyroid labs after ultrasound or aggressive palpation.
Do not test PSA after DRE.

  • 5000iu vit-D3 in tiny oil based caps
  • DHEA 25mg [take with a meal that has fats/oils, never high fiber]
  • high potency vit-B complex with trace minerals and iodine
  • CoQ10 50mg Ubiquinol form [take with a meal that has fats/oils, never high fiber]
  • vit-C
  • natural source vit-E [take with a meal that has fats/oils, never high fiber]
  • TRT
  • appropriate E2 management

Prostate:

  • get a good prostate supplement
  • manage E2 for lower levels and for higher T:E ratio to avoid estrogen dominance.

With your thyroid problem, many systems in the body are suffering. The upside is that fixing the thyroid issues will improve many different aspects of your health.

Please explain the need for potassium. ??

More labs:
full CBC
serum iron
ferritin
CRP
homocysteine

TP is correct, with your thyroid problems, you will not be able to support the renewed metabolic rates that TRT will call for and can be expected to “crash”.

What is the history of:

  • feeling cold
  • low energy
  • poor libido
  • these occurred together, or one took the lead?

Please respond to all questions…

Thank you TP and KSman for your reply.
I am looking also for a good tyroid specialist-would be nice to go on Yellow Pages and get one but things are not that easy…

Answers for KSman

‘‘Speaking of iodine, what has your history been of iodine in vitamins and use of iodized salt?’’
I don’t have any particular iodine hystory other than that we are using iodized sea salt in our cooking.Maybe is not enough -Wife could also be low on temperature so far I have a 9pm reading of 98.0 -investigation to be continued.

For my thyroid I don’t feel any lumps ,no odd feeling when I swallow-though I haven’t been seen by a doc yet

‘Blood in urine: Did you gave a CT scan for kidney stones’
The report states No calculi in the kidneys,ureters or bladder on the unenhanced images

Blood Pressure is good so far 125/80 but lately is creeping up maybe also due to those new worries I have readings like 135/92 aso

I am taking potassium because I used to have some cramps in the leg ,always at bed time and potassium and magnesium apparently fixed this;should I stop? on my metabolic panel potassium serum is 4.3 nmol/L on a range of (3.2 5.2)
I will definitely ask doctor to test me for CRP,ferritin,homocysteine-I see your point
(I don’t have a doctor yet but I scheduled an appointment with a TRT doc in a couple of weeks)

Prostate:

  • get a good prostate supplement
  • manage E2 for lower levels and for higher T:E ratio to avoid estrogen dominance.

What prostate supplement should I take and what can I do at this point to manage E2 for lower levels? I was kindly relying on Zn for this …

Thank you !

Zinc can have subtle effects. If one is deficient, then adding zinc would have a greater effect. If dietary zinc is adequate, the effect of added zinc must then be less. Often added zinc will not achieve objectives and one should not prescribe to more is better. E2 is OK and typical for many with T in your range. But those cases are characterized by estrogen dominance.

Prostate: start with reading here: Vitamins and Supplements Rooted in Science - Life Extension

This week I had my first appointment with a new doctor.I have been waiting for five weeks to get this appointment.
I got a day off at work,I got a confirmation call from doctor’s office,the night before I reviewed my notes,my questions, I put my home-works into a backpack and I got there ten minutes earlier.They repeated me the rules to make sure I got it right- 245$ out of pocket that buy me 45 minutes with the doctor.

And finally in the room entered a very young man,dressed up in a black suit with silver stripes ,introduced himself as Doctor BlaBla and quickly started to ask about my issue.I asked him where is the old doctor that I signed for and who also owns the practice
They must have run this scam many times because he didn’t even try to improvise something like he’s out of town or he’s sick today-he told me that mondays he’s not even in the building.
I asked the guy what is his experience (‘one year’)if he is a real doctor (‘‘Actually I am a practitioner nurse but I am working on some differences’’) and I left.
Was I too picky? At least they did not ask me to pay in advance
There are a lot of crooks out there IMO-we should be very careful.
No I am back to square one.
Does anybody know a good dr in MI.Somebody who would know about thyroid also Thanks!

Hi All,
Finally I got my bloodwork results and looks like there are a lot of surprises at least for me but let me list the results:
Testosterone total 379 (250-1100 ng/dL)
Testosterone free 78 (46-224 pg/mL)
Testosterone bioavailable 168 (110-575 ng/dL)
SHBG 17 (10-50 nmol/L)
Albumin serum 4,7 (3,6-5,1 g/dL)
FSH 3.6 (1.6-8 mIU/DL)
LH 3 (1.5-9,3)
Progesterone <0.5 (<1.4 ng/mL)
Prolactin 11.8 ng/mL (2.0-18.0)
Estradiol 21 (<39 pg/mL)
DHEA Sulfate 146 (45-345 mcg/dL)
DHT 28 (16-79 ng/dL)
PSA 1.1 (<4 ng/mL)
Cortisol saliva 8-10 am 0.45 mcg/dL (0.04-0.56)

ACTH Plasma 22 (6-50 pg/mL)
TSH 6.54 (0.4-4.5 mIU/Dl)
T3 Free 3.3(2.3-4,2 pg/mL)
T4 free 1.1 (0.8-1,8 ng/dL)
T3 reverse 16 (8-25 ng/dL)
IGF 1 176 (52-328 ng/mL)

Chplesterol total 213 (125-200 mg/dL)
HDL 49 (>40 mg/dL) LDL 131(<130 mg/dL)
Trigliceride 167 (<150 mg/dL)
GLUCOSE 93 (65-99)

So I have results that moved within the ranges and others improved
In the meantime I haven’t done anything special other than continuing to take my suplements and I consumed 1 pound of iodized celtic salt by myself
I am feeling the same ,what bother me most is a kind of brain fog,low libido,lack of strength-For some reason the energy level is not bad,
My daily temperatures average 96.7 C in the morning and 97.6 C at 9 pm.

So where I am ? Where should I go from here ?

Thank you for your time !

Your metabolic profile is pretty bad with high LDL, high normal glucose (diabetes) and high triglycerides. Definitely all can be cured through proper diet…high in fruits and vegetables and more ‘vegan’ less dairy. You already seem to exercise a lot. I would do 30mins of bike riding and 30 minutes of strength training to mix it up a bit and give your body an overall better work out. Hypothyroidism can cause metabolic issues however your thyroid hormones, while maybe not optimal, are within range meaning you are not deficient in these hormones and so fixing your thyroid alone probably will not work miracles on your metabolic markers and/or testosterone. You would probably be better off on an HPTA restart and an AI than taking testosterone as your LH is pretty low and as someone mentioned your estradiol is higher than it should be in relation to estradiol (which is seen in obese men)…Though estradiol doesn’t seem to be a major issue.

DHEA is very low. Supplement

You have thyroid issues that may require thyroid meds.

Check TPO and TGAB to rule out hashimoto. Ultrasound to rule out cysts and nodules.

Getting your thyroid fixed while lead to improvements in everything and easier weight loss.

Fix thyroid before doing TRT.

T might even improve by fixing thyroid alone.

Please respond in detail to my earlier response and tell me what you have done.