T Nation

Thyroid/Pituitary Disorders and Treatment

  Hi everyone.  I am a 20 year old college student.  I lead a fairly active lifestyle playing tennis for my college.  I am approximately 5'10" and 185 pounds.   Summed up, I suffer from borderline hypothyroidism and hypogonadism.  Genetics: My father suffers from hypothyroidism, but there is no noted hypogonadism.  Since the age of twelve, I have suffered from most all symptoms of each disorder to varying degrees; the main being: fatigue, depression, anxiety, and lack of motivation.  They have been life-altering.  The worst though, is the constant fatigue I have experienced which has turned me into a a "zombie-like" person.  I tried to combat it through lifestyle choices, but it seemed futile.  

 After twisting his arm for more than one year, my family physician tested my testosterone which sent me on a journey the past six months or so.  The first endocrinologist I visited recognized my hypothyroidism and hypogonadism as two different issues stemming from a thyroid and pituitary disorder.  As treating my thyroid required a lesser treatment, he prescribed me 50mcgs of Synthroid.  His plan was to treat my thyroid and determine if it was sufficient in relieving my symptoms.  Unfortunately, it was not.  The next step was testosterone substitution.  Knowing this is a more serious commitment, I searched for a second opinion.  A second endocrinologist confirmed both the diagnosis and need for testosterone substitution.  Through him, I began taking Androgel 1.62% four days ago.  I have had a constant headache but it seems to be subsiding today.  I also have chapped lips.  

 In the first reply, I have posted all my test results.  Please advise me with anything you consider useful as well as the treatment I present below.  Being a twenty year old with borderline results, I have been told contradictory information on both my diagnosis and treatment.  It is very confusing.  

 Right now I am trying to design a treatment that works for me.  Before I go into this it is worth mentioning that I have a girlfriend.   Transference is a worry.  Right now I apply one pump or 20.25mgs of Androgel 1.62%.  As I mentioned above, I experience constant headaches and dry lips.  I hope they continue to subside.  Recently, I have been familiarizing myself with Doctor John Crislerâ??s method.  I am considering implementing subcutaneous HCG injections daily.  My testicular function is important to me.  Please let me know your opinion on this treatment. 

If there are any questions I am more than happy to answer them promptly.

I am sorry the tests do not include units. I figured the range would provide sufficient relativity to interpret. If there are any questions please ask for units.

Testosterone, Serum: 265 (348-1197)

This was concerning, so another more extensive test followed.

TSH: 2.360 (0.450-4.500)
LH: 4.2 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
Testosterone, Serum: 330 (348-1197)
Prolactin: 8.5 (4.0-15.2)

The following test was issued by my first endocrinologist.

Free Testosterone (Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
LH: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)

The following test my first endocrinologist ordered because I had been off Prozac for one week and figured why not.

Cortisol: 20.8 (2.3-19.4)
TSH: 4.2: (0.450-4.500)

I had an MRI done, and the results came back clear.

This is the most recent test.

Thyroid Panel With TSH
TSH: 1.930 (0.450-4.500)
Thyroxine (T4): 9.6 (4.5-12.0)
T3 Uptake: 34 (24-39)
Free Thyroxine Index: 3.3 (1.2-4.9)
Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab: 8 (0-34)
Antithyroglobulin Ab: <20 (0-40)
Luteinizing Hormone (LH): 7.3 (1.7-8.6(
FSH, Serum: 1.3 (1.5-12.4)
Calcitonin, Serum: <2.0 (0.0-8.4)
Reverse T3, Serum: 21.5 (9.2-24.1)
Vitamin D, 25-Hydroxy: 32.6 (30.0-100.0)
Triiodothyronine (T3): 115 (71-180)
Estrogens, Total: 83 (40-115)
Ferritin, Serum: 70 (30-400)
Triiodothyronine, Free, Serum: 3.7 (2.0-4.4)

I do not know if this is important, however, these tests were taken at 8 AM. This could cause for the imbalance in some tests, as I had not eaten. I wonder if this impacted: Calcitonin, Serum; Ferritin, Serum, or Vitamin D, 25-Hydoxy

It is also important to note, I am currently taking 20mg of Adderall in the morning; 50mcgs of Synthroid in the morning; and 10mg of Prozac at night.

With thyroid issues, you need to be aware of iodine intake. Supplementation of iodine/iodide (in the form of Lugol’s or Iodoral) could help or completely resolve your hypothyroidism. You’ll need to take the supplementation slowly since you are already on Synthroid (don’t want to induce hyperthyroidism). KSman created a sticky on thyroid issues. You can obviously also google around for “iodine + hypothyroidism”. Paul Jaminet and his wife have good information on their website and in their book regarding iodine intake in the general population, the issues this can cause, and proper supplementation. You’ll also see the name of Dr. Brownstein appearing often while researching iodine supplementation.

You should get off the Androgel. I personally feel the risk of transference, especially to a partner, is too great to warrant its use. Aside from that, you’ll see a lot of men try Androgel and end up switching to intramuscular injections. From talking to multiple doctors and hearing about men on forums use the gel, it seems that the gel just doesn’t work as well (i.e. absorption issues). IM injections are tried and true: there’s no risk of transference and you know exactly the amount of T that is in the body. Better yet, you only have to deal with it once or twice a week.

[quote]celiac wrote:
With thyroid issues, you need to be aware of iodine intake. Supplementation of iodine/iodide (in the form of Lugol’s or Iodoral) could help or completely resolve your hypothyroidism. You’ll need to take the supplementation slowly since you are already on Synthroid (don’t want to induce hyperthyroidism). KSman created a sticky on thyroid issues. You can obviously also google around for “iodine + hypothyroidism”. Paul Jaminet and his wife have good information on their website and in their book regarding iodine intake in the general population, the issues this can cause, and proper supplementation. You’ll also see the name of Dr. Brownstein appearing often while researching iodine supplementation.

You should get off the Androgel. I personally feel the risk of transference, especially to a partner, is too great to warrant its use. Aside from that, you’ll see a lot of men try Androgel and end up switching to intramuscular injections. From talking to multiple doctors and hearing about men on forums use the gel, it seems that the gel just doesn’t work as well (i.e. absorption issues). IM injections are tried and true: there’s no risk of transference and you know exactly the amount of T that is in the body. Better yet, you only have to deal with it once or twice a week.[/quote]

Hi Celiac: Then certainly, I will have Iodine tested. I did not know it was such an effect on the thyroid. It would be desirable to take a supplement for that rather than Synthroid. Sometimes all these medicines I am on make me worried.

You are yet another of the numerous people I have asked that say injections are better than gels. Before I started Androgel 1.62% I wanted to take injections. I am very health-conscious to the point of excess so I have spent countless hours researching which is the “better” choice. My doctor pushed me towards Androgel 1.62%. Its hard to find one that doesn’t and I wanted to feel better. So I made the decision to try Androgel and see if it worked. I decided if it didn’t I would do everything in my power to take injections. Other than my doctor, there was a few other reasons Androgel 1.62% seems preferable: The gel’s ability to mimic the daily levels of hormones closer was appealing. It also seems that gels require less additive medicines than injections do. Lastly, DHT is low as well as my testosterone, so the effect is has on increasing DHT is desirable.

I have been at a crossroads between gels and injections for months now, as I am not easily swayed. It is such a complicated subject for someone without a medical background to fully understand. The time-frame I have to research and come to a decision is closing rapidly. My tennis season is in the spring so I won’t be able to start anything till summer if I do not make a decision soon. Please, if you have any information or words that can sway me, volunteer them. I do not want to go through another semester like the past.

Okay, you mentioned three reasons that gels are better than IM injection. My rebuttals, respectively: (1) I agree that the benefit of mimicking the body’s natural circadian rhythm is probably a good thing, but of course we can’t really pinpoint any reason why that would be the case (unless maybe LH and FSH would be released a bit by the pituitary when the daily Androgel T begins to lower – speculation on my part), so this becomes pure speculation. Probably good speculation, but speculation all the same. Also, this benefit assumes that the Androgel even gets absorbed, which, as I’ll return to later, may not be the case. (2) Could you specify what you mean by additive medicines? (3) I too have heard that transdermal testosterone will increase DHT more than IM testosterone, but this does not mean that IM testosterone will not increase DHT at all. If you are raising your serum T level, presumably some of that T, even if it is from IM injections, will get converted to DHT. You have low DHT because you have low testosterone. If you took IM injections and still had an issue with low DHT, then perhaps you would be an abnormal case, and you’d need to consider doing something about that. (Note - I believe compounded straight DHT cream is an option if this were the case.)

What about the risk of transference? If I was in your position, I would be quite concerned about transferring T to my girlfriend. Can you imagine how horrible that would be to introduce exogenous testosterone into her body? Who knows how that would affect her. She certainly did not sign up for that. Even if you are extremely careful, can you be certain she’s not getting exposed? Can a thin cotton shirt prevent gel from getting on her hand if she touches your back? What if she uses the towel you’ve used for the past month to dry off and gets exposed that way? For me, this would be far too much to worry about, and I couldn’t bear to put someone I cared about in that position just for my benefit.

Lastly, I want to tell you what one doctor I saw told me in regards to gels/creams. This doctor specializes in TRT treatment and has been for the past 15 years or so. He has a lot of patients and consequently a lot of experience. I asked, having read similar things that you read about the gels/creams, why he only did IM injections instead of gels/creams. His response? The gels/creams stop working. Even if they do work from the get-go, they stop three, five, seven months down the line. For some reason they lose their effectiveness and the man using them is forced to end up on the shots, which end up being a godsend because they simply worked. This doctor claims that he actually confronted the Androgel (or Testim, I can’t remember) salesman about this issue, and the salesman admitted that it was a problem.

I am in the same position as you, and I am choosing shots. My five cents.

[quote]celiac wrote:
Okay, you mentioned three reasons that gels are better than IM injection. My rebuttals, respectively: (1) I agree that the benefit of mimicking the body’s natural circadian rhythm is probably a good thing, but of course we can’t really pinpoint any reason why that would be the case (unless maybe LH and FSH would be released a bit by the pituitary when the daily Androgel T begins to lower – speculation on my part), so this becomes pure speculation. Probably good speculation, but speculation all the same. Also, this benefit assumes that the Androgel even gets absorbed, which, as I’ll return to later, may not be the case. (2) Could you specify what you mean by additive medicines? (3) I too have heard that transdermal testosterone will increase DHT more than IM testosterone, but this does not mean that IM testosterone will not increase DHT at all. If you are raising your serum T level, presumably some of that T, even if it is from IM injections, will get converted to DHT. You have low DHT because you have low testosterone. If you took IM injections and still had an issue with low DHT, then perhaps you would be an abnormal case, and you’d need to consider doing something about that. (Note - I believe compounded straight DHT cream is an option if this were the case.)

What about the risk of transference? If I was in your position, I would be quite concerned about transferring T to my girlfriend. Can you imagine how horrible that would be to introduce exogenous testosterone into her body? Who knows how that would affect her. She certainly did not sign up for that. Even if you are extremely careful, can you be certain she’s not getting exposed? Can a thin cotton shirt prevent gel from getting on her hand if she touches your back? What if she uses the towel you’ve used for the past month to dry off and gets exposed that way? For me, this would be far too much to worry about, and I couldn’t bear to put someone I cared about in that position just for my benefit.

Lastly, I want to tell you what one doctor I saw told me in regards to gels/creams. This doctor specializes in TRT treatment and has been for the past 15 years or so. He has a lot of patients and consequently a lot of experience. I asked, having read similar things that you read about the gels/creams, why he only did IM injections instead of gels/creams. His response? The gels/creams stop working. Even if they do work from the get-go, they stop three, five, seven months down the line. For some reason they lose their effectiveness and the man using them is forced to end up on the shots, which end up being a godsend because they simply worked. This doctor claims that he actually confronted the Androgel (or Testim, I can’t remember) salesman about this issue, and the salesman admitted that it was a problem.

I am in the same position as you, and I am choosing shots. My five cents.[/quote]

I must say, through all my online forums you put this the most succinctly. Thank you. I want to begin by saying I did not present those three reasons to claim that gels are better, just why I chose them. You are correct, it is speculation. It is obvious to me though that it must be beneficial, even if it can’t be detected with modern medicine, that gel mimics natural hormonal levels. By additives I refer to medicines like AI’s. Interesting, you you’re saying that compounded gel can be just DHT? That is something to think about.

You frightened me with that second paragraph but thank you for it. I needed that. I am very concerned about it. I already had a close encounter and I have been on it for four days! To be honest, I am not as worried about me as I am worried about her relaxed attitude towards it. She doesn’t seem to be worried at all so she might be careless, which I don’t blame her for. After all, she didn’t sign up for this. It just isn’t right to put her through that unless it is absolutely necessary. I wouldn’t want to hurt her and who knows the havoc it could reek on her body. It would be selfish to risk that. By chance, do you know the effects it might have on her?

I am glad you brought that up. If I kept record of each time I read about topical applications losing their effectiveness…

Still I wonder, maybe gels are something to be trailed. If I had a compounded gel it would be much easier to cover, thus avoiding the issue of transference. If it was to lose effectiveness I could simply switch to injections.

You seem very logical about this. It is very refreshing considering most I have encountered give me their subjective opinions even when it is not asked for. If it is okay could you tell me more about your situation and how it is similar to mine? I feel it may help. I would love to read a detailed version

You cannot get DHT as a drug.

You were on T-gel for this:
“”"
Free Testosterone (Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
LH: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
“”"

Read the “thyroid basics” sticky.

[quote]KSman wrote:
You cannot get DHT as a drug.

You were on T-gel for this:
“”"
Free Testosterone (Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
LH: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
“”"

Read the “thyroid basics” sticky.[/quote]

You’re saying my endocrinologist most likely put me on gel instead of injections with purpose? And I will read them, but the majority of the time I will post information anyways for discussion. I normally have more questions than answers provided.

I understand that this is a difficult question, but from my story above does it seem like I should be on TRT? People (not doctors) have told me that there may be other causes of my symptoms, and that the treatment of these could raise my testosterone. Or that natural treatments may help. I refuse this because I don’t want to just get by on borderline testosterone at my age. This is a time where I am deciding my life and I will not be stopped by hormonal imbalances. When the tests above were taken my lifestyle was great so I feel as if any changes from this point absent of TRT will have no large affect on my testosterone or other hormones. Thus, I believe TRT is necessary to balance my hormones to that of a 20 year old. Any thoughts?

You were on T-gel because of this of this was the result?
Free Testosterone (Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
LH: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
“”"

If you can find a cause of your problems, then you may be able to fix the root cause. Many guys and docs see low T and go for TRT, sort of a tunnel vision. Find and treat the cause or treat the symptom. You should go on TRT if you cannot find a root cause and fit that.

Natural treatments are often inadequate.

We cover a lot of ground in the stickies. We do expect lots of questions.

Can we have temperature readings and intake of iodine in vitamins and use of iodized salt?

[quote]KSman wrote:
You were on T-gel because of this of this was the result?
Free Testosterone (Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
LH: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
“”"

If you can find a cause of your problems, then you may be able to fix the root cause. Many guys and docs see low T and go for TRT, sort of a tunnel vision. Find and treat the cause or treat the symptom. You should go on TRT if you cannot find a root cause and fit that.

Natural treatments are often inadequate.

We cover a lot of ground in the stickies. We do expect lots of questions.

Can we have temperature readings and intake of iodine in vitamins and use of iodized salt?[/quote]

Yes. Treating my hypothyroidism did not balance my testosterone nor relieve symptoms sufficiently; thus, I am on TRT because of those results you mentioned.

I agree, however, I am not one of those people. I understand that there are many potential causes to low testosterone. In fact, I hoped for one that could remedy both my hypothyroidism and hormone imbalances. Unfortunately, two endocrinologists have deemed me with separate thyroid and pituitary issues as I mentioned in my original post. I suspect they have their reasons. Neither hesitated in the diagnosis. I know this is a difficult question for one without a medical degree to answer, but from my results do you think I should put faith in their decision or search for yet another opinion.

(1) I do not know what you refer to with “temperature readings”. (2) I am going to assume you mean the iodine I receive from my vitamins. In that case, the answer is none. (3) I do not know what you mean by “use of iodine salts”. Are you referring to what I consume from my foods?

I am considering visiting a strongly recommend doctor for this. Will I need to discontinue my Androgel 1.62% before visiting him? I don’t want my being on TRT to prevent him from diagnosing me. If that is not the case, I want to stay on.

So you are on T-gel and your T levels suck. Another sign of hypothyroidism.

Thyroid Panel With TSH
TSH: 1.930 (0.450-4.500)
Thyroxine (T4): 9.6 (4.5-12.0)

If that is with the thyroid meds, the dose is ineffective.

You are iodine deficient. See the sticky and take action.

[quote]KSman wrote:
So you are on T-gel and your T levels suck. Another sign of hypothyroidism.

Thyroid Panel With TSH
TSH: 1.930 (0.450-4.500)
Thyroxine (T4): 9.6 (4.5-12.0)

If that is with the thyroid meds, the dose is ineffective.

You are iodine deficient. See the sticky and take action.[/quote]

I’m sorry I am confused.

To my understanding, TSH is optimal at 2 and my T4 is in the middle/upper end of the reference range. This seems appropriate. Why do you think otherwise?

Do you think I am Iodine deficient simply from my imbalances? What in my results make you think that?

We start to get concerned when TSH goes beyond 1.0 Why do you think otherwise?

Thyroid meds should reduce your TSH.

Where are your body temperatures?

If you are not getting iodine, you think that that is ok?

[quote]KSman wrote:
We start to get concerned when TSH goes beyond 1.0 Why do you think otherwise?

Thyroid meds should reduce your TSH.

Where are your body temperatures?

If you are not getting iodine, you think that that is ok?[/quote]

I didn’t know it was concerning if TSH was over 1. I thought otherwise because there are many differing opinions. Normally between 1.5 and 2 is what I came to understand.

The tests that I have up are what I have had done.

I didn’t say that was okay. I asked why you thought that.

We see iodine deficiencies with TSH in the ranges that you suggest, with lowered body temperatures.

Post your damn body temperatures. This is frustrating.

Hey Nate,
Read and re-read the stickies - all of them. And then read the thread “KSman has a problem.” It will help you understand the importance of temperatures and iodine.
Take your temp upon waking, then every few hours throughout the day. Do this for a few days then average them from day to day. Post the results here on your thread.

Thoughts on your lab numbers:
Your Free T3 does not look horrible.
As mentioned above, your TSH is high.
Your vit D is was low. - Get on something for that.

Testosterone levels are obviously low. - It looks like the cause could be your lowish LH and low FSH.
This means the problem is with your pituitary, not your nuts. (secondary hypogonadism vs primary)

Your levels are about where mine were before stating TRT. As mentioned above, docs seem to just start prescribing stuff to mask the real problem. If I were you I would try to address the pituitary and thyroid stuff rather than using exogenous testosterone.

Good luck man.

Joe

[quote]KSman wrote:
We see iodine deficiencies with TSH in the ranges that you suggest, with lowered body temperatures.

Post your damn body temperatures. This is frustrating.[/quote]

You could of explained that. And it is frustrating. I told you that those were the tests I had done, and I didn’t know if I could measure my body temperature myself or if it needed to be done in a lab.

Hi Joey B: Thanks for the response.

[quote]Joey B wrote:
Hey Nate,
Read and re-read the stickies - all of them. And then read the thread “KSman has a problem.” It will help you understand the importance of temperatures and iodine.
Take your temp upon waking, then every few hours throughout the day. Do this for a few days then average them from day to day. Post the results here on your thread.[/quote]

Okay, will do. Do I need to stop the Synthroid I am on? If hypothyroidism results in a low body temperature, thus indicating Iodine Deficiency, then I wouldn’t I need to stop it for accurate diagnostics?

[quote]Thoughts on your lab numbers:
Your Free T3 does not look horrible.
As mentioned above, your TSH is high.
Your vit D is was low. - Get on something for that.[/quote]

I have been supplement about 1,600IU of Vitamin D since that test.

[quote]Testosterone levels are obviously low. - It looks like the cause could be your lowish LH and low FSH.
This means the problem is with your pituitary, not your nuts. (secondary hypogonadism vs primary)

Your levels are about where mine were before stating TRT. As mentioned above, docs seem to just start prescribing stuff to mask the real problem. If I were you I would try to address the pituitary and thyroid stuff rather than using exogenous testosterone.[/quote]

Well that’s great yours is similar to mine, because I am lost. I thought it was a good idea to address the pituitary and thyroid issues before exogenous testosterone, but I don’t know where to begin. Apparently neither do my endocrinologists, as they both prescribed me Androgel 1.62%. So I accepted what doctors told me, that I simply had no specific diagnosis with Pituitary and Thyroid issues. If you could give me some more insight into what you’re referring to with tackling these problems, I would be very appreciative.

[quote]Good luck man.

Joe[/quote]

I should add. I live in a wealthy, suburban area. I know places are subject to lack of Iodine, but I doubt mine would be one. So if this was the problem, I guess it would be with my processing of it?

Thanks again for your response. It was very helpful.

[quote]Nate92 wrote:
I should add. I live in a wealthy, suburban area. I know places are subject to lack of Iodine, but I doubt mine would be one. So if this was the problem, I guess it would be with my processing of it?

Thanks again for your response. It was very helpful.[/quote]

What does this have to do with anything?

Places aren’t subject to lack of iodine, peoples dietary choices can subject them to lack of iodine.

Is most of the food you eat prepared with this?
http://content.costco.com/Images/Content/Product/276638b.jpg

and no, restaurants and prepared foods don’t count they use sea salt) Do you eat a lot of soy?