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 …
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?
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.
Thanks a lot for your involvement, appreciate it.
So tamoxifen is a good alternative to hCG ? I don’t want to jeopardize my fertility. Sure, I’m cryopreserving my semen as a last resort in terms of covering all tracks but I still don’t want to sell my self short in terms of what’s the most effective treatment would be to retain it.
For estradiol, me and my doc have been very clear. I told my doc that I need him to be open minded with these drugs and doses if we are to have a good outcome and he agrees. He will be prescribing arimidex for E2 control. As I have noted in the threads, 22 is a good value for estradiol to be in.
Does nolvadex/ tamoxifen reduce e2? I assume it lowers chances of free estrogen binding to your receptors in case of gyno and of course get your testes producing again.
I can still get him to prescribe hCG though, but would rather avoid it if nolvadex can do the job! Straight into pinning 5 times a week at 23 for the rest of my life or at least till I’m satisfied with babies that I make is a long time, and I’ll admit a daunting task to be comfortable with.
Are there any studies that show tamoxifen as an alternative to hCG? Would like to weigh up the possibility. All the studies i have read only indicate hCG +T. Never Clomid/Tamox + T. Also, I have seen people say on this board saying SERM should not be an option for long term. I won’t be trying for a baby prior to the 2021 or so.
For thyroid/IR, 50 mg includes the iodide or no? I’ve taken 4 12.5mg tablets today = 50 mg, however each tab has 5mg iodine and 7.5 mg iodide.
Thanks and again appreciate your help. @KSman
Also, I read again your sticky on TRT protocol, there’s a a post that describes my hypogonadal state :
" TT=1000 in a young man is not the same as TT=1000 in an older man with higher SHBG levels as the FT numbers will be well below that of the young man with the same TT. This may very well create TT levels that are above the youthful lab ranges and should not be a concern. Lab ranges shown on lab reports will be age adjusted. You need to be using the ranges for youthful men."
Since the reason of me being hypogonadal is not due to the Testes failing to produce adequate numbers but SHBG being so high, I am worried about this.
Even though i have done countless readings in the last month about this, I gathered that exogenous testosterone reduces high SHBG in men, i.e, more of your exogenous T with your TRT will be unbound. Is that not so? Will i need to be put above the normal range of TT to be in range for FT even on exogenous treatment?
I am sorry for so many questions, but i’m new to all this and need to find clearer answers. TRT is a big step and i don’t want it to imperfect. If you find the time, please re read my background and what i can do? I can’t see any abnormality other than high SHBG which is blocking Free T, don’t have a reason for that as well. Most of our discussions has been centred around Thyroid function and i am taking iodral now as you recommended and will revisit that again in the next month. However, i need your opinion for TRT urgently. How can i be in good Free T range and lower SHBG on TRT?
With high SHBG, you should be looking for higher than upper range FT and not worry about TT been high. Can also use bio-T.
To get good representative FT numbers, inject more often and do labs 1/2 way between injections. Do not change that timing as that will create timing artifacts.
The higher FT should reduce SHBG. SHBG can be increases by extreme diets/starvation. SHBG is made in the liver to scavenge estrogens from the blood. Its based on the female system; remember that males have most of the same hormone controls.
You have to get you doc on board with this approach. Most docs do not think in the realm of functional medicine.
Tamoxifen/Nolvadex is an alternative to hCG. I did not say a better alternative. It does have better potential to preserve fertility than hCG. I have suggested hCG with Nolvadex holidays to provide some FSH benefits.
To see if Nolvadex is working properly, you need to do LH/FSH labs. Dose should not be high. 10mgED or 20EOD would be sufficient. Any [potential] sides will be dose proportional.
SERMs do not increase E2, SERMs increase E2. High dose SERMs create major E2 issues. You need an AI to manage E2 to target levels. Anastrozole cannot manage E2 from high dose SERMs.
SERMs block E at E receptors in selected [not all] tissues. See the definition of what a SERM is.
hCG is a natural human hormone, SERMs are not! Long term use of a human hormone does not create problems like a foreign drug.
Take 4 12.5 iodine tabs to get 12.5x4=50
Exactly what i was hoping and expecting to hear. Thank you. I talked with the doc today about explaining with what are we expecting from TRT, what are we shooting for? He said we are only going to be looking at FT and will test after 3 weeks in between the 2 injections of the 4th week to see what FT stands at and adjust the doses accordingly. He said that nothing can be done to directly lower SHBG, and we should not concern ourselves too much about TT and SHBG levels and look at FT and E2 levels during the therapy and with mid to high range FT, SHBG would probably decrease. SHBG reduction doesn’t really mean more FT anyway! Without high SHBG, my TT would probably be down as well, SHBG values seem to just falsely elevate my TT. My doc seems to understand pretty well of what is going on though, thankfully. That could be the reason for a relatively higher starting dose at 150mg/wk pinned twice a week, to get the FT up to high range. I know there’s no particular answers on this but do you think 150mg/wk is good dose to get those FT numbers up? or could i need higher than that? I hope not.
Also, i get what your point now with SERM/hCG to a certain extent. Me and doc have found agreement with hCG+T + AI. With Nolvadex holidays, do you mean cycling Nolvadex on regular intervals or stop hCG and add Nolvadex during those period at the suggest doses? Another point in the dose of hCG, doc cites 500iU EOD as an optimal dose. Is it unnecessary? or more means better in this case? Some studies also cite 500iU dose+ T for spermatogenesis.
Also, hCG mimics the LH production in the body but not FSH, so FSH will be totally shut down with just hCG but hCG still has a high success rate in terms of fertility retention. FSH as we know is key in spermatogenesis. So how does it work in retaining fertility? Some are also prescribed hMG. Curious as to how this works.
We do not see guys on T+hCG having broad fertility issues.
You would swap Nolvadex for hCG and never use both together.
You get T from T injections. Using twice as much hCG and twice the cost has little benefit and may cause E2 problems.
In any case, you can do some sperm analysis along the way.
Two guys have tried to make babies and discussed using a SERM but got pregnant before they got to that stage. With hCG, there is some FSH cross receptor activation. Could there be some FSH in the LH? Perhaps…
Got it, big thanks. I’ll run with 250iU EOD then.
I have browsed around all similar cases on T-nation and have encountered some suggestions of Nettle root supplementation to lower SHBG and increase FT. Don’t believe it’s as easy as it sounds. Even if it was to suppress SHBG levels to a small extent, E2 would also rise and i believe TT would be also be lowered in my case without increasing FT. More E2-> worse symptoms. What’s your take on it?
Yes, more FT means more FT–>E2, and you need to deal with E2 management in any case and that will all come out in the wash. Don’t get overly analytical, make the changes and deal with what the labs say happened.
I’m still bummed as to finding a cause for high SHBG and the subsequent low FT. I possibly didn’t have to research so many papers for my B school than i the readings i have done. I am at a healthy weight despite difficulties in gaining muscle and losing body fat. Despite all this and muscle wasting, i remain at a healthy weight and decent bf %age.
Although, i was obese in my formative years, does that explain my condition? I have also had 2 separate periods of around 6 months with high stress, but i was fine after the situation had resolved and cortisol levels are in check i believe, could that lead to permanent high SHBG levels?
I haven’t had any chronic illnesses, apart from the sinusitis, which developed about 5 months prior. Never starved myself to an alarming degree even when i lost my excess weight, i was restricting calories but it was never lasting for a long time.
What do you think? @KSman
Also, since my estradiol is high and FT less. Could i just run an AI and see if reduced E2 levels lead to reduced SHBG levels and increased FT. I know probably won’t work but no harm asking.
E2=22pg/ml is still your target.
Lowering E2 can have multiple good effects. Your LH/FSH was very good.
Prolactin is also a problem and 0.5mg/week cabergoline would reduce that if you can get an Rx. I also suggested that you could have an adinoma.
And your thyroid needs work.
What have you done so far?
I was referring to an AI only treatment right now, before any TRT. Would low dose AI, and the decreased E2 values show any significant improvement in SHBG and FT? I don’t think an E2 value of 36 can effect SHBG to such levels but still thought would ask for you opinion. As for TRT, E2=22 pg/ml is what i’d be shooting for.
I am getting a repeat lab work next week, to eliminate risk of distortion. Last time, i feel that the cernos wasn’t out of the system and led to some distortion of results. I discussed with doc about Prolactin values, he said they’re in range and tumours and such usually produce >80 values at least but he said if you are concerned, we will follow up with repeat blood test and check again. Caber is not necessary imo at least with just one lab for prolactin, let’s see if there’s an issue first.
For thyroid, like you suggested i’m doing IR. 50mg for 2 weeks and then 12.5mg/week for maintenance, then will get more temperature readings along with some repeat thyroid labs.
Lab update :
@KSman please look at these, got repeat lab work reduce possible distortion from Cernos that could have been active during the last blood test.
TT: 751 ng/dl (250-900)
FT : 5.1 pg/ml (4.25-30.5)
E2 : 33 pg/ml (0-40)
SHBG : 67.54 nmol/l (14.5- 48)
LH : 4.14 mIU/ml (1.5-9.3)
FSH : 4 mIU/ml (1.4- 18.1)
Prolactin : 10.15 ng/ml ( 2.1- 17.7)
Hematocrit is 49% up from 46.6% 2 weeks ago.
SHBG is rising with every draw and with it Total T but Free T is looking lower than ever. LH and FSH are lower from the previous set of labs.
Do not do thyroid labs during or soon after IR.
E2 is still adverse and with low FT, you are very estrogen dominant.
Most of your TT is T+SHBG that is not bio-available.
So there is not enough active T to push SHBG down.
Injected T might push SHBG down if you manage E2 correctly.