Routine Eval Bloodwork, Low Free T. Typical Low T Symptoms. 23yo

Yes, i asked the doc, I don’t get sick as often as i have been in the last two months and it’s the chronic sinusitis that i’m having trouble with. No other diseases and have been perfectly healthy throughout this last year till now when i started getting acute sinus attacks, maybe twice in the 3-4 months and then developed into a chronic state. I just got a CT scan to confirm it last week. Treatment slipped out of mind due to this T concern.

What do you think about Thyroid, my endo and urologist weren’t too concerned about the thyroid values at all. I am not too knowledgeable about Thyroid and would appreciate better explanation about your concerns about my thyroid values.

Thanks for your feedback.

That link explained that low thyroid function can cause sinus congestion and lack of drainage may lead to infections.

Do you finish the antibiotics or stop when you feel better?
Worried about antibiotic resistant bacteria.

Please get your oral body temperatures. Your feeling warm may not mean what it feels like.

T3- 84 ng/dl (Range- 60-200)
T4- 8.8 ug/dl (range- 4.5-12)
TSH- 1.41 uIU/ml (range 0.30-5.50)

TSH is better closer to 1.0
T3, T4, fT3, fT4 should be midrange or a bit higher.
T3 is low.
Mostly interested in fT3, fT4

fT3 is what gets the job done. Your low T3 is worrying. fT3 may be low.
T4–>T3 may be impaired.
Low ferritin is associated with reduced T4–>T3 conversion.

I finish the course as my doctor recommends, in the past i have stopped when i feel better and have experienced a recurrence and the docs attribute it to not staying on the antibiotics course.

I will start recording my temperatures soon. Need to get hold of a new thermometer.

I understand that TSH is better closer to 1.0 but most of the bloods i have seen here are more closer to 2 and still have no thyroid problems so i thought i was good. Anyway, i’ll keep a closer eye on this.

Let me know if you require some new bloods, i’m getting tested in a few hours, i can get whatever tests you might need to assess further like Free T3.

Thanks again and please reply soon so that i am prepared for the blood work.

I see you have posted in the first reply to get tested for free T3 and free T4. I’ll go ahead and get tested for those as well.

All the values i’m getting tested for tomorrow then:

Total and free Test, LH, FSH, SHBG, Progesterone, DHEA, Prolactin, Free T3 and T4, Albumin, TSH, Total T3 and T4, Cortisol, Complete Hemogram, Estradiol (E2), Hepatitis Panel.

I guess that’s all we need, will post values of the latest blood work in the coming days. Let me know in the meantime if i missed anything. Getting all these done at 9am fasted.

I make my own kefir and use it everyday in my smoothies. Great source of probiotics IF you make your own. Really changed my life. I never have GI problems. Haven’t been sick one time since adding this to my diet. So simple. Order the kefir grains online and your good to go.

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I started a thread last week about low free T and hypogonadism.

To summarise, there was a European study that found low free T was a better predictor of hypogonadism than TT. The lower bounds of what constitutes a normal range hasn’t been determined, but it’s probably somewhere between 6 and 7 (maybe as high as 8) ng/dL.

Low free T is also associated with depression and anxiety. (I’ve been meaning to write a post about this.) It’s not certain which is the cause, and which is the symptom though.

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@KSman

I checked my body temperature on waking up and it was 97.3 F. Should i be worrying about hypothyroidism? During the day, it is around 98.6 F though.
Bloods will be coming in soon.

Get some more temperature readings to get a better idea of trends.

Getting to 98.6 is a good sign, things are not so severe.
You could supplement iodine and see how your body responds.

Actually it was 98.7 in the evening today. I have already ordered Iodral like you suggested to some other people, think it’ll take a week or two to arrive though since it’s gonna be shipped from the US and i stay in India.

Okay, so this is real weird, the blood work i shared in the OP was the sample taken on 16/2/16. I was seeing another endo from then to 26/2/16, who prescribed me a T-gel called Cernos 5mg, it has 10mg of Test USP. I applied for a day, i.e, 26/2/16 and saw my current endo who seems to be more aware than the previous. He ordered new blood work that i listed above and the sample was taken on the 02/3/16 as he told me not to take any medication or such for this until we get a more clear look over the next month. I will list some significant anomalies in the latest blood work. I think it could be the one day of the gel usage but it still seems odd.

Total T- 724 ng/dl (2/3/16) and 570 (16/2/16) Range (241-910)
Free T- 14.5 pg/ml (2/2/16) and 6.4 (16/2/16) Range (4.25-30.4)

T3- 106 ng/dl (2/3/16) and 84 (16/2/16) Range (60-200)
T4- 8.8 ug/dl (2/3/16) and 8.8 (16/2/16) Range (4.5-12)
TSH- 3.75 uiu/ml (2/3/16) and 1.41 (16/2/16) Range (0.30-5.50)

RBC- 4.38 (2/3/16) and 4.59 (16/2/16) Range (4.5-5.5)
Hematocrit- 46.8% (2/3/16) and 47.4% (16/2/16) Range (40-50)
Albumin- 4.36 gm/dl (2/3/16) and 4.46 (16/2/16) Range (3.2-4.8)

And some other hemogram value changes, like 125 point decrease in Platelet count, MCV up by 5% and above max reference point. I’ll post full Hemogram values if needed.

Now other Tests that i got done for the first time :

17 OH Progesterone- 1.47 ng/ml (0.5-2.10)
A4- 1.42 ng/ml Range (0.6-3.1)
DHEA Sulphate - 316.2 ug/dl Range (211-492)
FSH- 5.09 mIU/ml Range (1.4-18.1)
LH- 6.58 mIU/ml Range (1.5-9.3)
Prolactin- 17.21 ng/ml Range (2.1-17.7)
SHBG- 64.04 nmol/L Range (14.4-48.4)
Estradiol- 36.62 pg/ml Range (0-39.8)
fT3- 3.47 pg/ml Range (1.7-4.2)
fT4- 1.24 ng/dl Range (0.70-1.80)
Cortisol- 18.28 ug/dl Range (6.2-19.4)

So i’m really curious as to why some of these are as they are, surely one time use of Cernos Gel shouldn’t make so much difference in my blood work in the matter of 4-5 days, in my estimation it should have normalised after 2-3 days which i gave for it to be tested again.

Another very weird thing is my TSH is according to @KSman should be closer 1. I was at 1.41 on 26/2 and 3.75 in 5 days. How much could Cernos gel would have affected this? T3 is also elevated, probably for the better but still odd! Some hemogram differences are also concerning.

Would love your intervention here @KSman.

Were the labs done at different lab companies? Different ranges?

Some makes sense, some does not.

LH/FSH should be done prior to any TRT.

Please always provide lab ranges with labs.

India has a very complex politicized history of salt and iodized salt has not always been available.

Hi @KSman,

Big thanks for your insights.

Yes, Same companies. I know i made an error of judgement really. I wasn’t convinced of the doctor and i wasn’t finding better docs than him at the time and had not learned from this platform, not to forget desperate for some of the symptoms to go away.

I did not provide ranges on the comparison bloods due to having provided in the OP for reference. I’ll just edit my post to reflect the ranges.

I was studying and working in Singapore for 4 years prior (lack of regular home cooking) to May’15 and maybe the iodine stores need replenishment and i have ordered Iodral for this and will practice your protocol. As i said in the earlier post, my family has always used iodized salt for preparation of meals and i eat atleast 3 meals at home everyday and Indian food is generally on the higher side with the salt.

I applied the Gel only once and it’s of a lower dose than American alternatives such as Androgel. I told my doc about it, he said that he would expect the blood to normalise in 2-3 days and then we draw the blood.

What according to you make sense and what does not? I am not educated enough yet to interpret the changes in some of these values, especially Thyroid values.

I cannot make any sense in how your thyroid lab values changed.

I also point out that arsenic in well water in your part of the water is a concern.

I am confused by your description.
We labs of 2/3/16 before the Cernos?

[I am concerned that you did not need TRT and problems may be thyroid and not low-T.]

@KSman,

2/3/16 was after Cernos that i used for only 1 day on 26/3/16. I made an error with the other lab tests dates, it was 16/2/16 instead on 26/2/16. TSH 1.41 was result of the lab taken on 16/2/16 and 3.75 was taken on 2/3/16. I talked with my doctor today about these lab results, and he confirmed that i need TRT after the calculated Free T was even lower than what my blood work suggests. ( Immunoassay is not the most accurate way of assessing Free T)

I wasn’t on any TRT prior, apart from the 5mg of cernos i applied on 26/2/16. Thyroid does not explain Mild ED though and my SHBG is extraordinarily high which explains low free T. My TSH has been closer to 1 in the two Labs that i have done prior to the latest one. fT3 and fT4 are also mid range.

I asked the Urologist about the Thyroid values today and he said that he doesn’t believe it to be a problem since 2/3 labs show it to be healthy, and he can refer to a thyroid specialist if i have further concerns regarding this. I haven’t started TRT yet so i would like to investigate further before commencing. However, does Thyroid function cause such low Free T levels and high SHBG? To my knowledge, i thought hypothyroidism can decrease SHBG levels.

See what iodine does before doing anything else re thyroid.

T3 mid-range is (60+200)/2=130, not some vague notion about been somewhere in the middle.

T3 is low, T4 is good, T4–>T3 may be impaired.

Prolactin is a concern. At some point one suspects a prolactin secreting adinoma.

I will get same labs done again in the next two weeks to see further. What about fT3, seems okay or not? The endo said that the fluctuation is worrying if it’s a trend in labs. Next blood work should give us a better picture. Could be the elevated Estradiol causing a fluctuation in TSH as well.

Another question, Since i’m 23 and my total T is okay, the doctor thinks that it’s an early onset of hypogonadism, since my SHBG is so abnormally high. The calculated Free T is even lower than the labs. What can i do to preserve fertility? i would want to reproduce 7-8 years down the line and i’m worried about the fertility. Doc is unsure about HCG but willing to talk about it. As of now, we discussed semen cryopreservation as a safety measure though.

If we can get your doc to think …

  • The LH active lobes of the LH and hCG peptides are identical.
  • 250iu hCG SC EOD was shown in a research paper to be an LH equivalent dose in a group of younger males.

fT3 was more than enough to support decent body temperatures
T3 was low, something is odd about that
Your body temperatures seem to be a mixed signal
We need to wait to see what the iodine will tell us.

Temperature has been fluctuating from 96.8-97.5 upon waking up since the last 3 days. Iodral will be delivered by the next week. Will start IR then, please guide me on the doses for Iodine, i have ordered 180 tabs of 12.5mg Iodral; 5mg Iodine and 7.5mg Iodide.

T3 as i said could be low due to illness when testing(16/2/16). Got better in the latest. Another set of labs 14 days from now could give a better picture for Thyroid.

Will also consult another Endo only for only Thyroid function, if i should? I have an appointment with current doc on 20th of this month. Will further discuss HCG in the TRT protocol with him then. As of now, he has ordered a Semen analysis along with blood work for the next consultation and provided everything is consistent to prior labs, Semen Cryopreservation will be done over the month of April. Currently, the discussed protocol stands at 150mg Test E/ 2x wk + Anastrozole if bloods after 4 weeks of therapy indicate high estradiol.

Is the TRT protocol okay?

@KSman

Please respond to the previous post, i would appreciate your take on it.

Another very important question i have is that my doc messaged me about use of Clomiphene as an alternative to HCG for fertility prevention purposes, did not talk about doses and such. However, Clomid use on TRT is not very common, some have sides with Clomid. He sent me a couple of research papers showing how Clomiphene works in maintenance and improvement of sperm counts in TRT patients preventing Testicular atrophy. Can you shed more light at this? Is Clomiphene a decent substitute for HCG for this?

Any one with any sort of information on this is welcome to share their views.

You can use low dose SERM for that. Suggest that you ask for Nolvadex as that will avoid the nasty side effects that some guys get. Try 10mg ED. 20 EOD. The problem is that Clomid was the first SERM and research was done to see what it could do. Researchers did not see the point of repeating that work with each new SERM that came to market. The medical community has problems seeing what was obvious to the research community.

When on a SERM, you can test LH/FSH to see what happening. Or go by how your testes are with hanging and firmness/size.

You do not want to be constrained by what a doc typically thinks high E2 would be. You want to be doing things that optimize your quality of life: libido, mood, initiative, fat patterns

You can take 50mg iodine ED for 2 weeks, reduce if guts get unhappy as gut flora will be affected. Or 25mg for 3-4 weeks. Then 1 tablet once a week or 1/2 X 2 for maintenance. Do not do thyroid labs during the iodine loading or for a few weeks following. Later, knowing that iodine deficiency is off of the table, your labs will be more useful. If body temps are good and you feel good, mission might be accomplished.

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