Low Testosterone or Low Thyroid? Help with Labs

Pharma / TRT Testosterone Replacement
1

Hey guys,

I am a 24 year old guy. 170cm height, 63kg weight. About two years ago now I began experiencing ED. In addition, I noticed a host of other symptoms, including loss of libido, increased abdominal obesity and breast development, hot flushes, acne, bloating and loss of muscle tone. I went to my GP on numerous occasions to seek a diagnosis and was told, as many of us on here have been, that “everything is normal” and that it is purely a psychological issue. I’m sure most would agree having ED and a non existent sex drive in your 20s is in fact far from normal!

After much cajoling, I persuaded my GP to test my major sex hormones. I attach the la results below and would welcome your advice and interpretation of the same. I personally think low testosterone and potentially under active thyroid are the root cause of my symptoms, but would appreciate your insights.

Total testosterone= 17mnol on a reference range that goes from 10-30mnol (given I am at the lower end of normal, I believe this could be at the very least contributing to my symptoms)
Free testosterone= 0.343pmol/L
TSH level= 4.79mul on a reference range that goes from 0.34- 5.60mu/l
Oestrogen (E2)- 151 pmol/l- reference range goes from 73-172- this to me is higher end of normal
SHBG= 41nmol on a reference chart that goes from 10-50- higher end of normal again
FT3 = 10.1 on a reference range that goes from 7.70-15

My GP has told me that my total testosterone levels and my TSH levels are sub-optimal for a young otherwise healthy man of my age. GP said that total T for example should be a minimum of 25-30mnol for optimal sexual drive and muscle development. Oestrogen is at higher end and I have classical symptoms such as mild breast development, bloating, hot flushes and emotional disturbances.

GP has offered me Testo Gel, but nothing for fertility like HCG or indeed an AI to keep the oestrogen levels in check. Likewise, she tells me TSH is not low enough to warrant any form of thyroid replacement. Question to you guys is: if you were in my position and my stage of life, would you pursue the TRT route, or would you request a referral to an endocrine doctor for further evaluation of your thyroid related symptoms? I am desperate to feel like a young man, rather than a 80 year old!

Any guys on here recommend any private TRT clinics in the UK, preferably London or nearer, who specialise solely in TRT regimes? My fear is that, even though my GP has done the NHS proud for once by offering treatment based on symptoms as well as blood test numbers, with all the will in the world she does not know enough about TRT to develop for me an individually tailored treatment plan which takes account of my concerns regarding fertility and oestrogen dominance etc.

Given my age and the costs of accessing hormone therapies, I am keen to explore all avenues before committing to TRT or similar. However, I simply CANNOT continue living like a eunuch with no libido, ED and the cluster of other symptoms related to hormone problems. I welcome your input and your interpretations of my labs.

2

You will waste time going through the NHS, they aren’t knowledgeable enough to diagnose a man with hormone problems, they routinely deny treatment and say you’re fine when you’re aren’t. There’s no way to determine whether or not your FT is midrange or not because you don’t include lab ranges. Your TSH is terrible. There’s no way your lack of libido and erections are just low T, you’re missing a lot of thyroid tests and the NHS just will not give you. Once you start paying for things doctors are more than willing to run a battery of tests, you must go private!

3

Hello.

Yes I am currently under the care of a private clinic in London. It was the GP there who put me on the Testo Gel. However, when testing my thyroid hormones he noted a TSH above 2 can potentially cause or worsen the symptoms of low testosterone. You say my TSH level is terrible; what is an ideal TSH level? My fear with the NHS specialists in relation to hormones is that they adopt this “one size fits all” attitude, whereby if your numbers fall within this arbitrary reference chart, then it matters not how high or low those same numbers may be and what symptoms you may be experiencing, they simply will refuse to treat you for economic rather than health reasons!

Are you saying that my thyroid levels could be playing a larger role than initially thought with respect to my “low T” symptoms? Have you yourself ever been on Levothyroxine or similar and did this improve your symptoms?

Taking hormone therapy comes with many risks, so before I commence the Testo Gel, I want to be sure THAT IS WHAT I ACTUALLY NEED!

Welcome your views and insights also about oestrogen numbers, as they also are higher end of the reference range and I am symptomatic also.

4

Most robotic doctors wait for “disease status” or until things are 100% bad, when you’re 75% bad they will tell you you’re normal. Your TSH is getting near the threshold requiring treatment. Your T levels are low for your age and right now you’re competing with president Trump’s T levels, and he’s 71 years old and you’re 24. If you do the math and you start losing 1% of your T after the age of 30 where do you imagine you’ll be by the time you hit 71 years old?

Your fT3 looks alright, but not if your rT3 is high which blocks fT3. Your E2 while is within range when converted to our range would be considered a few points over the top, so I agree with you that it’s over top of normal. Your bigger problem will be controlling E2 levels once you begin TRT and the inability to get the correct E2 test in your country will complicate matters for you! Most guys end up quitting TRT for that reason alone. Your AI dose will have to be based off how you feel and not what we recommend, in order to dose the AI properly you must know your actual E2 levels.

5

Indeed, NHS doctors seem obsessed with reference charts and tables, not at all concerned about critically analysing the results on the paper and the patient’s symptoms! You say my TSH level is getting near the threshold for treatment; with levels like this do you think my GP or endo would prescribe me Levothyroxine or should I go private? You mentioned in an earlier post about the need to have a battery of thyroid tests. Can you advise further as to exactly which tests I require, as then I can go private and order them. I have had TSH, T3, T4 and FT3 and FT4 done. All apparently “normal”, but in light of my TSH number being higher end of normal and my symptoms, I do not agree with that assessment.

In relation to testosterone levels, I think 15mnol-17mnol is undoubtedly low for my age, and given my symptoms think I may have low testosterone for my age. Hoping my doctor can give me a good TRT protocol which also takes account of my concerns regarding fertility and conversion of test to oestrogen, as again my levels are higher end of normal and I have symptoms indicative of high oestrogen. What level of total testosterone should a man of my age be aiming for with treatment? 21-25mnol is what my GP seemed to think we should be aiming for, as a minimum.

Thank you for your insights and your guidance. Look forward to hearing from you.

6

Don’t forget reverse T3, if this is high it will seem to your body that your fT3 is low in the same way high SHBG shrinks your FT. A high TSH indicates your body is sensing something is wrong.

TSH
Free T4
Free T3
Total T3
Reverse T3
Thyroid Antibodies