T Nation

Thyroid and TRT

Hello All,

I’m new on here, deciding to join after browsing for some time. There seems to be many knowledgeable and helpful people posting.

I’m a 48 year old male living in the UK. I have been suffering from the symptoms of low T for some years now. Main ones are low libido, often feeling lethargic/drained, some depression and low confidence. The exception is that my strength levels have been increasing steadily in the powerlifting exercises. I am in generally good shape at 93kg and approx 22% body fat.

I have been on TRT (transdermal) now for almost three months, after having low testosterone levels confirmed by two blood tests. It doesn’t seem to be working, despite my levels now coming up toward the upper end of the normal range.

I am suspecting a thyroid problem. I have had a thyroid blood test done by Medichecks, and have received the results recently:

TSH: 4.73 mIU/L (0.27 - 4.20)
fT4: 13.30 pmol/L (12.0 - 22.0)
fT3 5.81 pmol/L (3.10 - 6.80)

Thyroglobulin and thyroid peroxidase antibodies are at <10 and <9 IU/ml respectively.

From these, it appears that my TSH is high and my fT4 is low which would indicate hypothyroid. However, my fT3 levels don’t seem too bad.

I have started measuring my temperature with a digital thermometer (Geratherm Color), which is rather low:

05:30am 35.9°C (96.6°F)
09:00am 36.1°C (97.0°F)
14:30pm 36.3°C (97.3°F)

Some other results from an NHS blood test which may be of help:

Ferritin: 48 ng/mL (30 - 480)
Haemoglobin: 141 g/L (130 - 170)
Haematocrit: 0.435 (0.400 - 0.500)

These results were done at around 3 weeks on TRT.

While my T level is now fairly high, my E2 level is quite low at <44 pmol/L (0 - 192).

The only other thing I can think of is that I was treated with (Ro)Accutane for cystic acne when I was a teenager.

So I guess my question is, where do I go from here? More tests (rT3) for example? Try iodine or iron supplements?

Any help greatly appeciated!



Men with thyroid problems do not absorb transdermals. Men who are on injections build more muscle than those on transdermals.

Accutane is linked to health problems and low testosterone and sexual dysfunction. Accutane has cause permanent sexual dysfunction is some people.

You need Reverse T3 tested, Reverse T3 can negate good Free T3 levels since it competes for the same receptor. Essentially Reverse T3 blocks Free T3 at the receptor, so it doesn’t matter how good Free T3 levels are.

Thanks for reply.

I am absorbing the gel exceptionally well. I am on 40mg Testogel per day and it has put levels way up. Unless you mean that my receptors aren’t absorbing the testosterone from my blood? That’s a good point. Funnily, I have just ordered a book called Testosterone Resistance by Dr Malcolm Carruthers. I haven’t received it yet, but I think it contains a lot of info on symptons persisting despite decent T levels, due to bodily resistance.

I have read many of the bad side effects of Accutane, which includes possible thyroid damage. My sex organs work well enough though; it’s the lack of libido that’s the problem. Having said that, there is the occasional day when I have pretty decent sex drive. However, an orgasm will knock me down again for a good while.

Good point you mention about the rT3; I’ll have to look into getting that tested.

So much to consider…

Thanks again!

Accutane and finasteride are both thought to be making permanent changes to gene expression or a type of receptor damage. High estrogen will kill your libido and erections, sadly a lot of doctor refuse to test for estrogen let alone manage it.

When I first started TRT an orgasm would wipe me out for days, now it doesn’t affect me much as I dial in my TRT protocol.

I’ve started taking desiccated liver tablets to see if that will give me a boost for now, before looking in to selenium and iodine.

So, you haven’t really addressed your thyroid? Thyroid functioning affects testosterone levels. I wouldn’t wait to supplement with iodine and selenium. Your thyroid levels are off by enough that I would suspect an iodine deficiencies. Even more telling is your low body temperature.

Yeah, I went about things the wrong way. I should have looked for thyroid problems before jumping on to TRT. I have been taking 200mcg of selenium for a week now; I am still waiting for my iodine (Iodoral) to arrive.

Strangely, my body temps are often lower by mid afternoon than what they were before I got out of bed. I haven’t been working in a particularly cold environment or anything, so who knows?! Weird.

Good. Your numbers are a little odd since your fT3 seems to be okay but your pituitary glad is telling the thyroid to work harder to get to those levels. It could be an rT3 issue or just a deficiency. Anyhow, give us an update when you can.

Ferritin looks really low - could be an iron issue? B12? Those would def effect energy levels

Yes the fT3 is a bit confusing. Having said that, it’s not at the high end either. I wonder if my receptors could be somewhat resistant to this hormone? If so, this could turn out rather complicated. I may be wrong, but I would expect fT4 to be higher if it was being converted to fT3 and rT3?
I will certainly keep y’all updated if I get anywhere. One things for sure; I’m still not getting any benifits from TRT after 3 months :frowning:

Possibly… I have started taking liver tablets. Maybe I need to go on a stronger iron supplement for a while? The confusing thing is that while I usually feel weak and wobbly before a heavy weighlifting session, I often feel on top of the world for several hours after it. Maybe that’s purely an endorphin rush though…

By all means, check your iron and ferritin, but due to the fact your body runs so cold, and your lab results, I’m really suspecting a thyroid issue, which would corroborate with your statements about feeling lethargic despite having added strength while on TRT.

I don’t want to sound like a broken record but you’re just not going to see optimal benefits from TRT if your thyroid is underperforming.

I agree your fT3 could be higher. I agree that I would expect a higher fT4 if you’re having a fT3 issue, but the only way to know is to check.

I hope you feel better after a few weeks of iodine replenishment. Good luck.

Thanks. I hope so too. Just to clarify; my strength gains were coming long before TRT. I have worked bloody hard, consistently, to get there though. Worth mentioning I do include deload weeks as well.

So I am confused. But I agree with your suggestion regarding a thyroid issue. I guess I need to break this down into steps. Iodine for a few weeks, and if no improvement, possibly natural desiccated thyroid…

FYI my waking oral temperature is normally 97.7 at 8am or earlier.

I checked my temperature a couple of hours ago, about 2pm here, and it was 98.6. I check it twice to make sure the thermometer is not off.

My waking temperature may be a little high but right now I’m trying to fine tune my thyroid meds. I may be slightly overmedicated. To me it’s staggering that your body could run on such low temperatures.

Interesting! I do seem to be quite low on the temperature scale. Sometimes I wake up wondering if I’m in the morgue, with these readings :slight_smile: Seriously though, I checked that I am taking readings correctly; thermometer under tongue etc.

Something else I have been pondering: thyroid issues may cause low estrogen levels, which I have. Another symptom I suffer from is urticaria; usually caused by cold conditions. That seems to be related to thyroid too.

So thanks for your responses; they have given me renewed drive to get this sorted. Starting with thyroid!

One other thing that comes to mind - you mentioned you feel great after the gym (when blood pressure is high). Might be something to look into… I know for me garlic makes me feel like a zombie sometimes for days… not a super technical answer but sometimes it’s the simple things

That’s another possibility; I do like these kinds of foods, so worth keeping an eye on…

Got an update on how things are progressing:

I have been supplementing with Iodoral iodine and Thorne selenium. I started on 12.5mg iodine for a day then progressed up to 50mg for about a week. I have since backed off slightly to 37.5mg as I had some fatigue and anxiety; possibly due to bromine detox. I am keeping selenium at 200 mics. Anyway, my body temps seem to be rising this past couple of days. Still a bit low in the morning at 36.3°C/97.3°F but improved a fair bit mid afternoon at 37.0°C/98.6°F. So it seems to be working, though it is early days yet.

I have backed off on my TRT dose for past week, as I don’t want to tax my thyroid too much until I can sort the issue out. I reckon my T levels should still be around mid range.

After reading STTM, I am now looking at more of my NHS test results which I now understand may be relevant:

Haemoglobin 141g/L (130-170) {lowish}
RBC 4.67 (4.50-5.50) {low}
RDW 13.9% (11.6-14.0) {high}
MPV 9.8fl (9.4-12.3) {low}

So there may be an iron, B12 or folate issue there; possibly worth doing an iron blood test first?


Got another couple of labs done:

IRON 21.39 umol/L 5.8 - 34.5
TIBC 60.61 umol/L 45.0 - 72.0
TRANSFERRIN SAT. 32.52 % 20.0 - 50.0
FERRITIN 83.4 mcg/L 30.0 - 400.0
CRP 0.67 mg/L 0.0 - 5.0


06:00 33.2 nmol/L 6.0 - 21.0
12:00 5.0 1.5 - 7.6
16:00 3.8 0.0 - 5.5
21:30 1.8 0.0 - 2.0

I have completed my iodine replenishment at a total of 900mg. I am now taking a kelp supplement at 300mcg per day, or every other day. My body temps have come down a little bit, typically 36.1°C / 97°F on waking and 36.7°C / 38.0 °F mid/late afternoon.

I have just started taking Thyrogold bovine NDT at 150mg every morning. I intend to top-up my iron levels a bit with some iron bisglycinate.

Hopefully this will help.

Any comments / advice most appreciated.

It looks like you are concerned about thyroid but I see no recent labs.
Can you post?

I’ve learned with subclinical hypothyroidism you also need total t3 and total t4.