T Nation

Thyroid Linked Low T. Nolvodex or TRT? Root Cause?


Attaching test results here.

Started taking Levothyroxine 125 and Tamoxifen (Novlodex) 20mg and both Thyroid and T have improved significantly.

I’m unsure what’s the next step of investigation? I suppose I need to lower the dosage of Levothyroxine to perhaps 75 as TSH is now close to 0?

It is clear that it is not primary hypogonadism as T has risen after taking meds. So, the problem seems to be that my pituitary gland isn’t producing enough LH/FSH and Tamoxifen stimulates testicles to produce more T. So, should I keep taking Tamoxifen or do I now need to get into TRT + HCG injections twice weekly?

Also - I’m quite worried about injecting myself. Is there something like a Testosterone Pen? I know HGH comes in Pen (auto-injector) form but I haven’t found anything for T. How about Testopel implants or cream?


Folks, I’ve been self medicating as the doctors are not very helpful. Plus, I no longer have insurance. Would really appreciate help in deciding next steps of action so I can move forward with identifying exact root cause and potentially address the root cause itself (if it is curable) or ultimately (if all else fails) go on TRT + HCG + AI routine.


You really need SHBG tested, otherwise you are guessing at dosing and injection frequency. Twice weekly does work for the majority of men.


Hi @systemlord - thanks for your reply!

Well, the lab here did not offer SHBG testing. I’ll try to find other labs. But I’ve just received free T results. It is 31.98 (range: 3.84 to 34.17 pg/ml).

Technically, it is total T minus what got converted to Estrogen and what got bound with SHBG. So, looks like SHBG is probably not super high as free T is close to high-end of the range.

Does this mean my problem was simply low Thyroid? Or does it mean I’ve to take Nolvodex forever?

Also - what are your thoughts on Thyroxine dosage? Is 125 too high because latest results show TSH close to 0!


I agree, SHBG can’t be too high given your Total T to Free T ratio, twice weekly is a good bet. Me on the other hand don’t fully respond to twice weekly even with excellent numbers, but 15-20mg EOD.


Thanks again @systemlord

Can you also help me with Thyroid dosage question?

Also, reading between the lines, it seems like you are not advising me to stay on Nolvodex forever. You think I should switch to injectable T. So, I suppose, this also means, there are no more tests to run. It is a case of secondary hypogondadism and the only solution is to take T in injectable form. Novlodex was only temporary to diagnose whether I suffered from Primary or Secondary hypogonadism, But now that we know it is secondary, I should switch to TRT twice a week.

Am I correct in my understanding?

Also 1 more question:
I’m able to get sustanon 250 here, not other type of Test. sustanon 250 seems to have a long half life. So, do I still need to inject it twice a week or once every 2 weeks?


Advise, please. Help me with figuring out if I need to adjust down or up my Thyroid dosage?


You need to get off of the T4 only medication. If your body doesn’t convert T4 to T3 effectively then taking T4 is worthless. Try an NDT thyroid medication like Armour that has both T4 and T3. Or perhaps a T3 only medication. There are conversion charts out there that tell you how much to take to match what you were taking with Synthroid (Levothyroxine). T4 only meds are nothing but disasters for most people. Try https://stopthethyroidmadness.com for more info.


Thanks, @trifive but how do we know my body isn’t converting T4 to T3? Since I started taking T4 med, my fT3 has increased from 1.8 to 3.93 so it must be converting well?


Shoot sorry, I missed your most current labs…looks like it’s doing fine! But still check at that website for lots more info on the meds and how much to take.


Thanks, @trifive again for your quick response. My concern is that since I started taking levothyroxine my TSH went to almost 0. I was wondering if I’m taking too high of a dosage?

I’m taking 125mcg ED. I’m about 70kg, 155 lbs, 5’10, 35 year old male.


If you go to that site I listed they will tell you that being at 0 or even slightly below is just fine and even desired. Next time you get your labs done get the reverse T3 tested as well. If you have lots of T3 but lots of rT3, the the T3 is not as effective. I have high rT3 and am on a T3 med only that stops the T4 from being converted to rT3.