T Nation

Questions about Thyroid Labs

I have been on TRT for a year now - taking 200mg/wk TC, 250iu EOD hCG, and 1mg/wk Adex. My T levels and E2 are stable (though the hCG doesn’t really help with the testicular atrophy so feel free to chime in if you have any suggestions about that one).

A little over a month ago I found out I was hypoadrenal and started taking Cortef. At the time the labs were taken that confirmed my low cortisol (poor results from ACTH Stim test and saliva test), I also had a thyroid panel and was wondering if the results need to be followed up on as I am still having some issues with fatigue. With the introduction of Cortef I am doing much better, but don’t quite feel “there” yet.

Labs done 10/9:

TSH 2.24mIU/mL (.40-4.5)
fT3 2.9pg/mL (2.3-4.2)
TT3 100ng/dL (76-181)
fT4 1.0ng/dL (.8-1.8)
Thyroglobulin Antibodies <20 (<20)
Thyroid Peroxidase Antibodies <10 (<35)

Labs done as part of a different battery of tests by primary doc 9/25:

TSH .91uIU/mL (.27-4.2) Different lab, different range
Homocysteine 7umol/L (<11)
rT3 22.1ng/dL (13.5-34.2)

So, even though everything is “in range” I was wondering if there is anything out of the ordinary that I should check on next time I get labs done. I have more lab numbers available if necessary, but felt that this would be enough to determine whether I’m having thyroid issues.

Also, if anyone would like to weigh in on hCG not making my testicle (just the one, lost the other to cancer) normal-sized that would be great too, but I’m more concerned with the thyroid stuff at this point. The hCG has gotten rid of the pain I was having, and help a little with the recession, but the guy doesn’t hang as low or is as big as he used to be. I’ve tried lowering the T dose, but that doesn’t make a difference and I feel noticeably worse when I take less testosterone.

Thanks.

The only thing I notice is a change in your TSH in one month. FT3 and FT4 are a little low. How is your iodine intake? any significant changes in that month? soy consumption?

Did you start HCG from day one of TRT?

Where are you getting the hCG from? Was it delivered wet or dry? Was is subjected to temperature extremes been shipped to you?

If hCG is fake, then you will be negative on a home pregnancy test.

Read the ‘advice for new guys’ sticky, note the first sentence.

Post your body temperatures.
Using iodized salt or sea salt?
Iodine in your vitamins?
History of both.

What numbers for DHEA-S?

All of your thyroid levels are lowish, should be near mid range, except TSH that should be closer to 1.0
Best outcome: You are iodine deficient, do iodine replenishment and problem solved.
A thyroid problem can make you feel off.

Thanks for the replies. I get bhCG testing as part of cancer follow-ups and my levels have been elevated ever since I started taking hCG (about 3 months into TRT - or in March), so I’m guessing it’s the real thing. I get it from a local compounding pharmacy. Although, that bhCG test was taken a few months ago and the most recent batch could be shitty. Do I just pee on the pregnancy test? I’d rather not have to get the bhCG blood work if there is a loop-hole that way.

I haven’t taken body temps as I haven’t been concerned about thyroid until recently. I’m starting that tomorrow. I don’t have a lot of salt in my diet, but started taking iodoral a couple days ago. Probably should have waited until after I did the body-temp thing…

I think I’m going to get another round of thyroid labs because 6 months ago my fT3 was .1 over the range, and my TSH is bouncing around. Hopefully it is just an iodine issue.

The pregnancy test is not for you. It’s to test the hCG that you bought. You get one of the pregnancy tests that uses drops - not the kind that make you pee in a cup.

You put a couple of drops of the hCG on the test strip. If it reads positive, then you probably have real hCG. If not, then you have a knock-off.

Pregnancy tests do work when injecting hCG. But may not be useful in detecting testicular cancers. And not all testicular cancers are hCG producing.

Just an update. I’ve been taking my body temp the last two days, and will do so for a couple more to get a nice set of numbers. On Monday I have another set of labs ordered, one of which is the bhCG test since it’s cheaper than going out and buying a pregnancy test.

So, about three days after that last post I came down with a pretty awesome case of pneumonia! Needless to say, I haven’t gotten my labs done yet as I am just now on the mend, but I will be getting them on Monday.

My hCG passed the pregnancy test, and I checked with the pharmacy to make sure they had their supply tested for potency. The Chief Pharmacist said that he would get back to me when he found out when the last time their supply had been tested.

My morning temps were consistently in the low-to-mid 97’s, and my afternoon and evening temps were anywhere from the low 97’s to the upper 98’s. I spent two weeks taking Iodoral, as I didn’t see how taking some extra Iodine would be a bad thing (I have a history of being nutrient deficient). After that I took my temps for another few days and the score were the same.

So when I get my next round of labs back I will post the results. I basically just made this post to bump the thread so it’s relatively fresh in peoples’ minds when I post my labs next week.

Also, if anyone knows whether taking more than 250iu EOD of hCG for long periods of time (i.e. the next 5 or so decades I plan on being alive) please chime in with any experiences or literature.

Thanks!

Okay, got my labs back:

TSH 1.81 (.40-4.5)
FT4 1.3 (.8-1.8)
TT3 109 (76-181)

TT 619 (241-827)

PRA, LC/MS/MS 9.53 (.25-5.82) no idea what this is. something with kidney stuff
Plasma ACTH 23 (6-50) I am currently taking Cortef for diagnosed adrenal insufficiency

DHT 14 (16-79)
DHEA-S 84 (110-510)
Pregnenolone 7 (13-208)

Hetmatocrit 53.6 (38.5-50.0)
Hemoglobin 17.8 (13.2-17.1)

Okay, so what is going on in here?

I was planning on starting propecia because my hair is starting to thin/fall out, but I’m guessing with my low DHT that that would be a bad idea. Low DHT would also explain some of my sexual dysfunction.

I spoke with my pharmacist (at a compounding) who in turn talked to his mentor about the hCG not retaining testicular size/mass and he said that adding clomid may help. I’m skeptical that clomid would be able to overcome the amount of artificial testosterone in my system and assist in any testicular health.

It is obvious from my labs that my testicle isn’t pumping out the other hormones I want it to. I see my endo on monday, but would like a heads-up so I know what to ask for and why.

Thanks for your time!

I just wrote a long post and now it has disappeared?

And now it’s back n/m

As you can see, your DHEA-S is low. I supplement with 50mg/day, and that keeps my levels in the upper 400s. It is my understanding that the pregenolone test is not reliable and that the progesterone test is a better indicator of pregnenolone levels (pregnenolone converts to progesterone). I supplement with 25mg pregnenolone and that puts me within acceptable if somewhat high range on progesterone. I think KSman will tell you to get a gel for these two, but speaking for myself I find tablets do the job.

One of the justifications for including HCG in the protocol is promoting pregnenolone production, but I was on HCG for months before I discovered supplementing with the above two hormones was also necessary. I suppose HCG does not work for me or you in that regard.

http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_AldoPRA_Ratio

Was your hypogonadism primary or secondary?

You need DHEA and preg. hCG is not getting that job done.

SERMs can create LH and FSH when you are on TRT.

Low: TT3 109 (76-181) is that fT3?

Iodoral: How many mg’s in total did you take? Two weeks at 50mg/day?

Hetmatocrit 53.6 is a problem. How is BP?

My BP has been out of control (high). My typical BP is ~140/90. It’s usually lower when my weight is under control, but with all the issues lately I’ve had several extra pounds. I also have a history of high BP (even when I was “healthy”) and have a family history of high BP.

I took 50mg of Iodoral a day for just over two weeks.

The labs say T3 Total (triiodothyronine).

I was diagnosed with Primary Hypogonadism, likely due to having testicular cancer. At the time of diagnosis I had high-ish (high end of the range) LH and FSH and everything else was normal (except low testosterone).

So what do you think is the plan of attack? What should I add and at what dosages? What about my DHT? Propecia a no-go?

What are your thoughts on a do-over? Cycle off and try again? Probably not the best idea, but I’m kind of at my wit’s end; Everything was great for the first three months of TRT, but since then I’ve been progressively falling apart!

Thanks guys for your input.

EDIT: I just read that link to Quest, and it says that being on beta-blockers can give false positives. I have been on a beta-blocker for a couple weeks now for tachycardia. Don’t know if that helps, but it might.

You cannot restart primary. If you are primary, the effects of hCG will not be much better than LH.

Tachycardia: Try vitamin K, but note: http://en.wikipedia.org/wiki/Vitamin_K#Anticoagulant_drug_interactions

T4 is well below mid range, body temps still not improved?

Have you seen the new sticky: thyroid basics.

With your hematocrit you cannot add more T!

Where is E2 and FT?

E2 was at 18. When I was taking 200mg/wk (and still 1mg anastrozole) my E2 hovered around 23. For some reason I didn’t have FT taken with this run of labs.

My body temps stayed within .2 degrees after the run with Iodoral.

So you don’t think I should add Clomid as it will have a negligible effect on testicular size? If you do think I should try it, what is the recommended dose?

What’s going on with my DHT, and is there anything I can/should do about it? And with low DHT, it’s recommended that I shouldn’t touch propecia, right?

Just thought I’d ask: would switching from Cypionate to something else be beneficial? Since Test-C seems to be insufficient in keeping my DHT levels in a good place, I wonder if a different product would be better.

T esters do not change to DHT, only T does. The ester is immaterial.

T+SHBG cannot change to T, E2 or DHT, it is garbage. Bio-T can change to E2 and DHT. We do not have bio-T or FT.

Not sure of your T protocol and lab timing, but TT suggests increasing T dose to get more DHT, however, you cannot do that with your hematocrit as stated before.

You can make more DHT with some transdermal T, but more DHT will accelerate hair loss.

You cannot worry about low DHT and take an oral 5-alpha reductase inhibitor, but there are some shampoos that may be helpful.

Clomid cannot do anything majorly more than hCG for testicular size, its a 'primary problem. You can try it, will have same limitations as it is still LH receptor mediated.

So basically I am looking at staying the course but adding pregnenolone and DHEA? Do you think this is what is causing my fatigue issues?

I probably have screwy thyroid, but I’m not clinical on anything so getting “treatment” would be impossible, at least in the ‘legit’ sort of way.

Would you recommend another round of Iodoral? I finished off an entire bottle, and there is iodine in my multi, so I’m guessing I’m not iodine deficient. I’m not sure if my doc would order the lab to test that (she would, but begrudgingly), but I can try if you think it is necessary.

If I decided to try Clomid, what would you recommend for dosing? What should I look for in terms of adverse effects?

I just checked my labs and my SHBG was 12 (10-50) if that is any help for anything.

I’m also wondering about the strength of the hCG I get. I asked the pharmacist to do a quality check to make sure that their supply is at the appropriate levels, and he said that he’d do so, and that it would take about a week. I haven’t been able to find a reliable online source for hCG, so I’m stuck paying $86 for 4k iU.

I see my endo at 11am PST, so if there is any labs that I need to order, or anything important I should know, please let me know before then.

Thanks all who are following this.