Secondary hypogonadism with high E2 as a factor, possibly liver mediated.
Suspected iodine deficiency.
High E2 is driving up SHBG then more SHBG+T inflates TT numbers.
Suspect that LH/FSH are depressed by elevated E2. But more may be wrong.
FT4=.083 is well below midrange. Has he stopped using iodized salt and become iodine deficient. If so, others in his house could have issues too. He can check his body temperatures as per the thyroid basics sticky.
Sea alt, Kosher salt and Himalayan Pink salt are ruin lives.
Need these labs:
LH/FSH <-- must be before any TRT
occult blood test
DHEA-S is getting low, try 25mg
Did he mess with steroids or 5-alpha reductase inhibitor hair loss drugs?
Liver problems may be reducing clearance rates of E2 and SHBG+T. Can be a problem with the liver or Rx/OTC drugs that complete for the same liver enzyme pathways. List all drugs, Rx, OTC, supplements etc.
Direct him to the stickies:
- advice for new guys
- things that damage your hormones
- finding a TRT doc
Low iron stores [ferritin] and elevated free iron suggests a long term low iron situation and recent iron rich meal or supplements. Iron can be low from GI bleed blood loss. So ask about changes to digestion. Occult blood test will be useful and CBC. Also need to know about older and new food sensitivities.
you or he take sleep aids or stay awake aids?
A good immediate intervention would be 0.5mg anastrozole per week in divided doses.
Please work all of the points above. He should also have his own thread here. Ping me at 'KSman is here' thread when you post here with more info.