T Nation

New to HRT, Thyroid Issues


#1

I am 42 yo, 5'10 195lbs. 36 waist, I run at least 2 times a week, weight train 3-4 times per week, I do yoga almost every day(got totally rid of ALL back problems), I usually weigh 180-185, been hitting the gym hard since starting hrt. My appetite is elevated since starting hrt, so I have put on some fat too. I look good and have been getting a lot of positive feedback about my musculature lately. I feel strong and confident, assertive and decisive. I think my problems have been around for a few years....I noticed lower libido and fatigue and fog...lots of fog and loss of memory.

I had diminished libido, overtook forever to orgasm,very tired all the time. Was not fat or out of shape....sort of pleasantly cloudy in my thoughts and now that I look back felt sort of female-ish. But something was wrong. Used a Florida clinic to start testosterone therapy here are my relevant numbers from that round of blood work.
TT,serum 390. 348-1197
Free 5.6. 6.8-21.5. Low
Estradiol 20.3. 7.6-42.6
TSH 6.9 0.450-4.500
WBC 7.4. 4.0-10.5
RBC 5.23. 4.14-5.80
Hemoglobin 16.6 12.6-17.7
Hematocrit 45.9 37.5-51.0
MCV 88 79-97
MCH 31.7 26.6-33.0
MCHC 36.2 31.5-35.7 High
RDW 13.2 12.2-15.4
Total cholesterol 190. 100-199
Triglycerides 167 0-149 High
HDL 66. >39
VLDL Cholesterol cal 33. 5-40
LDL Cholesterol cal 91 0-99
FSH 2.5 1.5-12.4
LH. 4.6 1.7-8.6
Hemoglobin alc 5.2 4.8-5.6
IGF-1 181 64-210
Alkaline phosphatase,S 63 25-150
AST (SGOT) 20 0-40
ALT (SGPT) 29 0-44

Started 120mg test in 60mg doses every 3.5 days. Started 250 hcg twice weekly as per protocol I learned here. Started Iodoral 50mg daily to try to improve thyroid function.
Decided to see local osteopath. She liked my Crisler protocol and agreed with taking charge of my own health. We continued iodine and tested again. I was aware that if Hashimotos is present iodine can accelerate the destruction of thyroid, not sure if she knew this however. I was prescribed adex but did not start to use it until week 5-6 as I didn't think I needed it yet. She also suggested I use chrysin TD daily instead of using adex. I had never heard of chrysin so I looked it up and did not feel great about what Crisler says about it. So I never used it.
Things really improved,sex was better, I really thought I was not "into" my girlfriend anymore and was questioning my relationship, that changed with my improved sex drive. I started to use adex, first .25mg every 3days.....sex drive waned, then tried every 5days....Things were better but not great so I thought .25mgs every 7 days. At about this point I went back in for labs. As follows
TT 1102(she likes this) 348-1197
Free 26.8(she wants this down into range) 6.8-21.5
Estradiol 11(of course higher)
TSH 8.9. 0.34-4.82
Thyroid perox ab H 96. 0-34. High
T3 107. 71-180
Thyroglobulin <20. 0-40
SHBG 29.3( she wants this up) 16.5-55.9

Ok, she was confused about the estrogen levels,I told her that I was not into using a transdermal and had not used the chrysin, I have full custody of my two young daughters,but did not mention(yet) Crislers statement about Chrysin being 'dead', I am open minded and want to see her wisdom and depth of knowledge. We talked all about my Thyroid,Hashimotos,etc. She thinks Hashimotos is frequently caused by Leaky Gut and we are doing stool samples and will attempt to stop my autoimmune response. Until then I am on 60mgs Armour.
I told her I would stop taking adex(not even sure I really need an AI), and try the Chrysin, at her urging. She also asked if I was at the 42nd day of HCG usage, if so I should stop for 30 days then resume, that HCG should be cycled on that schedule.
So I started chrysin, stopped my twice weekly hcg shots and ......felt bad. Depressed and unsexy. So today, a week and a half later, I gave myself a shot of HCG. Wow!! Feel great, and didn't rub myself with chrysin. Week and a half from today I am scheduled for new labs, I think I should take no AI and test myself with only testosterone and see where I am naturally. I also should say that the week of labs I took no hcg shots. Thoughts?
Here are some more relevant numbers again, from my last round
ANA reflex. Neg.
Free T3 3.05. 2.0-3.50
Free T4 .81. 0.45-1.63
Prolactin ,S 8 3-13
PSA-Screening 0.42 <4.0

So here are my concerns:
1) I do not want to use chrysin for these reasons: don't know if I even need AI, don't want to use it because it is a SERM and may give false Estradiol test results, and Dr. Crisler is hesitant to keep men on a SERM long term, dosing is not controlled enough, and finally it's transdermal.
2) Why get SHBG up? (she says it shuttles testosterone to tissues and receptor sites)
3)Why does she want my free T lower?
4)Why does she say to cycle HCG?
I am starting to think I may need to have that talk with her about...you know,..."Dr ____, how can I give you updated male hrt info and both of us feel great about it?"

I Take daily:
200mcg. Selenium
60mg zinc
10,000iu vitamin D3
50mg Iodoral
Subligual b6/b12
900mg Nettle root
Fish oil 1200mg(started as after those triglyceride numbers)

My diet is ok. Never eat total junk, no processed food or fast food.
I do own a bakery but don't over eat with white flour either. Lots of meat, fats, vegetables,salads. I am a single parent and so I do not eat like an elite athlete, sometimes my kids just need food, but we eat pretty well on the whole. Never drink soda, stopped diet soda.


#2

1 - wrong, is not a serm, research these things so you know
2- wrong, SHBG does not transport T to tissue, SHBG+T is not bio available. Many are confused about this. No reason for higher SHBG.
3- who knows, use the [edit] in corner of post about and add lab ranges to everything. Do not even know your age. In any case, you want high normal FT youthful ranges, not age adjusted.
4- cycle hCG? She is an idiot. When you made enough LH/FSH, that did not cycle!
5-Most docs are idiots and make things up for reasons unknown, or perhaps just confused.

Actions:
Read these stickies:
- advice for new guys
- - pay attention to causes of low T and things that we often see with low T
-- provide a lot more info !!!!!!!!!!!!!!!!!
-- post all of your labs
- finding a TRT doc
- thyroid basics
-- what was your history of iodine intake from salt and vitamins?
-- post your waking and mid afternoon oral body temperatues
--- if low, thyroid dose is too low


#3

Armour dose is too low. Check temps. With Hashi you want a dose slightly higher than needed to stop the attack. T4 is low you could probably benefit from a little synthroid.

200 mcg Selenium is very beneficial for Hashi. LEF has a very good selenium. I'd also recommend vitamin D and N acetyl cysteine, the last one has shown in studies to protect leydig cells.

Your E2 is too low, lower the arimidex. Your free T is really good top of the range is the goal. TT doesn't matter as much.

The ideal SBGH is low 20's. She has no idea what she is talking about. SBGH goes up with age and liver damage as well as high E2.


#4

Oooh.....read the stickys again....jeez I forgot all that, sorry. Will update and clean up my post. Thanks for the info.


#5

Crisler implies chrysin is a SERM here, but maybe I misunderstand


#6

Thanks for the help guys. Ok, updated my labs above.


#7

You need to get a thyroid ultrasound to make sure you haven't developed cysts or nodules. These are common with Hashi and can lead to thyroid cancer. These can secrete thyroid hormones including TSH, which might explain why yours is still elevated (aside from being under medicated). Please try to get this ruled out.

TSH 8.9
Free T3 3.05. 2.0-3.50
Free T4 .81. 0.45-1.63

Is this your latest labs?

I recommend you find the best and most experienced thyroid expert near you. TRT won't help much if this isn't addressed.

Free T3 looks ok, but FT4 which is reserve or slow acting thyroid hormone is very low, you could add synthroid to provide FT4. That TSH requires and ultrasound, not to mention all with thyroid issues should get one. Ultrasound should always be done after blood work as it can throw off the numbers.


#8

Yes Tunapancake, these are my latest. My TSH has elevated after 6 weeks of iodine replacement,we tried that first to see if any improvement.I did not have any thyroid panels done with my first labs from the Florida clinic other than TSH. These latest labs were before I started Amour, I have only been on Armour for one week.

My doctor thinks that if we can quickly determine, via stool samples, or detox elimination diet, what is causing leaky gut, then we can stop the Hashimotos autoimmune response. She says I do not have full blown Hashis' yet. She says we can fix this, and looks to take me off all thyroid hormone in a few months, she is enthusiastic and confident.

You can tell she is a healer not just a pure scientist. Her view is to treat the cause of the thyroid malfunction not the symptoms, other than the short term, which is why she put me on Armour.


#9

Thanks, those latest labs were prior to starting Amour, so that was just after 6weeks of iodine to see if that would help, in fact I had higher TSH. I have only been on Armour for a little over a week now.