Tired of My Doctor Guessing. Any Advice? Update 4/18/15

[quote]tcataz wrote:

Bill Roberts

  1. My doctor mentioned upping my thyroid meds but wanted me to try Androgel to see if that improved any of my symptoms.
  2. I should look into upping the dose? or will more iodine help with that?
  3. I am going to a TRT clinic on Wednesday I could have them test T3 and T4. My Dr. just did not test them last time to cut back on cost
    4)I don’t use hardly any salt currently, don’t really like it. BUT I will start adding it in. That is a reason I was looking at the tablets. The dosage level was because in the Thyroid Basic sticky it says from IR use 50 mg. Will Potassium Iodide work the same as Iodine?

You mention a current blood test. I had one on 3/18/15 should I take a more currently then that or should I wait for a few week until I have upped my iodine levels? Is TRT something I should look into?[/quote]
I was thinking your posted, older blood test was the latest but indeed you said you had one recently. That’s recent enough to be meaningful, if it’s at least a few weeks after your most recent dosage change.

On iodine, if eggs, saltwater fish, potatoes including skin, turkey, and dairy don’t make up a pretty big part of your diet and you don’t use iodized salt or take a supplement, almost certainly you’ll be iodine deficient and that alone could explain your thyroid problem.

If you increase your levothyroxine dose much, then your thyroid is unlikely to regain natural production as it will be suppressed by the added levothyroxine.

At your present dose, recovery of natural production could occur once correcting your iodine intake. So, because it sounds very likely that you were deficient, I’d want to correct that first and then see if the direction could be discontinuing the levothyroxine, or at least not increasing it.

It is worth testing for free T3; necessary really for a good picture of what’s going on (the closest single measurement you can get to the biological activity.)

Potassium iodide is fine as a supplemental source of iodine. Just be careful on the dosage as there are some extreme high-dose products out there, as with some iodine products also.

[quote]Bill Roberts wrote:

I was thinking your posted, older blood test was the latest but indeed you said you had one recently. That’s recent enough to be meaningful, if it’s at least a few weeks after your most recent dosage change.

On iodine, if eggs, saltwater fish, potatoes including skin, turkey, and dairy don’t make up a pretty big part of your diet and you don’t use iodized salt or take a supplement, almost certainly you’ll be iodine deficient and that alone could explain your thyroid problem.

If you increase your levothyroxine dose much, then your thyroid is unlikely to regain natural production as it will be suppressed by the added levothyroxine.

At your present dose, recovery of natural production could occur once correcting your iodine intake. So, because it sounds very likely that you were deficient, I’d want to correct that first and then see if the direction could be discontinuing the levothyroxine, or at least not increasing it.

It is worth testing for free T3; necessary really for a good picture of what’s going on (the closest single measurement you can get to the biological activity.)

Potassium iodide is fine as a supplemental source of iodine. Just be careful on the dosage as there are some extreme high-dose products out there, as with some iodine products also.
[/quote]

Thank you for you assist sir. I will get my T3 tested on Wednesday. What is your opinion on TRT in my case. My last Testosterone test was Free=70.0 and total=336. I know free is more important than total but my total seems low for my age for everything I have read/researched. My free is kind of middle of the road. Or would it be wise to get my thyroid/iodine issues fixed first then see what my numbers end up at?

Everything seems to be in range. Your T is pretty low… And your diet isn’t too bad either, I may just add in some carbs .

In regards to TRT:

It would be more beneficial in the decision-making process if you would get FSH and LH tested. This would indicate whether you are secondary or primary hypogonadism. If your LH and FSH are in a good range, then that means that you are primary and the testicles are not working properly and you will need TRT. If the FSH and LH are low, then you have secondary and the pituitary isn’t working properly and a SERM/ can be used to stimulate it to start working again and that should fix your low T problem. The main concern here is fertility. TRT will shut down fertility unless you incorporate HCG into your protocol.

In this case, it’s your decision. If you care about fertility and testicular size, you can either test FSH and LH and do a SERM/HCG restart (if the FSH/LH are low), or just hop on TRT and add HCG to maintain testicular size and fertility.

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[quote]Slasher917 wrote:
Everything seems to be in range. Your T is pretty low… And your diet isn’t too bad either, I may just add in some carbs .

In regards to TRT:

It would be more beneficial in the decision-making process if you would get FSH and LH tested. This would indicate whether you are secondary or primary hypogonadism. If your LH and FSH are in a good range, then that means that you are primary and the testicles are not working properly and you will need TRT. If the FSH and LH are low, then you have secondary and the pituitary isn’t working properly and a SERM/ can be used to stimulate it to start working again and that should fix your low T problem. The main concern here is fertility. TRT will shut down fertility unless you incorporate HCG into your protocol.

In this case, it’s your decision. If you care about fertility and testicular size, you can either test FSH and LH and do a SERM/HCG restart (if the FSH/LH are low), or just hop on TRT and add HCG to maintain testicular size and fertility. [/quote]

fertility is not really an issue. Two kids is all we want so that part of are life is set. I am just trying to feel better/get healthier. The last 3 or so years I have not felt right and it is getting worse. Thank you for you insight and I will do some research this weekend over the things you mentioned.

Simple answer, Yes. It took a concerted three prong process (diet, medication, stress-relief/rest/re-evaluated training) and it was a good 1- 2 year process.

I would have to say, perhaps I was a little over enthuse about my assessment of your situation. Its just a topic I’m passionate about it. So I apologize for that, if it came across any other way, then I had intended.

If indeed it is just a thyroid issue, all the advice above me, seems fairly solid.

Best Regards.

Human Growth Hormone: <0.1 : NT : <=2.9 mg/mL
You should test IGF-1 to eval GH status and not test GH itself.

Were you fasting for those labs?

You can use body temperatures as a thyroid medication dosing guide. Getting TSH “normal” is misguided.

TSH, High Sensitivity: 5.51 : 2.19 : 0.45-4.50 mU/L
T3 Free Non-Dialysis: 3.1 : NT : 2.0-4.8 pg/mL
T4 Free Non-Dialysis: 1.2 : NT : 0.8-1.7 mg/dL

TSH is very high, suggest that you also check for thyroid antibodies
Serum fT3 is not bad. When serum fT3 is good and body temps are low, rT3 needs to be checked.
Read thyroid basics sticky and note references to rT3, adrenal fatigue and stress

Then or now: Is your thyroid enlarged, asymmetrical or lumpy? Can you see your thyroid in the mirror? Are your outer eyebrows sparse? Dry skin? Feel cold easily.

You need LH/FSH before attempting TRT. !!!

Guys with thyroid functions typically cannot absorb transdermal T and you would be better off with self injecting.

If you go to a T shop, thats what you will get. What you really need is some diagnostic effort to find out why you have the symptom of low T instead of just covering it up.

Need these labs, you have some now:
FT
TT
E2
LH/FSH
AST/ALT
IGF-1
AM cortisol
Vit-D25

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[quote]KSman wrote:
Human Growth Hormone: <0.1 : NT : <=2.9 mg/mL
You should test IGF-1 to eval GH status and not test GH itself. [/quote]
I will get the IGF-1 test. My Dr listed the HGH.

[quote]KSman wrote:
Were you fasting for those labs? [/quote]
Fasting and in the AM.

[quote]KSman wrote:
You can use body temperatures as a thyroid medication dosing guide. Getting TSH “normal” is misguided.

TSH, High Sensitivity: 5.51 : 2.19 : 0.45-4.50 mU/L
T3 Free Non-Dialysis: 3.1 : NT : 2.0-4.8 pg/mL
T4 Free Non-Dialysis: 1.2 : NT : 0.8-1.7 mg/dL

TSH is very high, suggest that you also check for thyroid antibodies
Serum fT3 is not bad. When serum fT3 is good and body temps are low, rT3 needs to be checked.
Read thyroid basics sticky and note references to rT3, adrenal fatigue and stress[/quote]
I will have the rT3 tested. I really don’t think I have adrenal fatigue. I really don’t have that much stress in my life other than traffic.

[quote]KSman wrote:
Then or now: Is your thyroid enlarged, asymmetrical or lumpy? Can you see your thyroid in the mirror? Are your outer eyebrows sparse? Dry skin? Feel cold easily. [/quote]
No enlarged or asymmetrical thyroid that I can see. No thinning of outer eyebrow. Yes on dry skin. Don’t get cold actually the opposite.

[quote]KSman wrote:
You need LH/FSH before attempting TRT. !!!

Guys with thyroid functions typically cannot absorb transdermal T and you would be better off with self injecting.

If you go to a T shop, thats what you will get. What you really need is some diagnostic effort to find out why you have the symptom of low T instead of just covering it up. [/quote]
The only reason I looked at TRT is that my Dr put me on Angrol gel. With the wife and kids I did not want to deal with it so I thought injection would be easier. Will get LH/FSH tested before starting and do more research. I would rather not be on Androgel or injects if I can get things fixed and raise my testosterone without them.

[quote]KSman wrote:
Need these labs, you have some now:
FT
TT
E2
LH/FSH
AST/ALT
IGF-1
AM cortisol
Vit-D25
[/quote]
Will get those that I don’t have during my appointment Wednesday.

From the reading/research I have been doing over the last several days about iodine I think that I am low on iodine. I use hardly any salt and most of it is sea salt or seasoning salt.

Thanks for your help.

EDIT: In your opinion would it be better to cancel the TRT clinic appointment and look for someone to do my eveluation. I am sure the TRT clinic will recommend TRT.

[quote]tcataz wrote:

Thank you for you assist sir. I will get my T3 tested on Wednesday. What is your opinion on TRT in my case. My last Testosterone test was Free=70.0 and total=336. I know free is more important than total but my total seems low for my age for everything I have read/researched. My free is kind of middle of the road. Or would it be wise to get my thyroid/iodine issues fixed first then see what my numbers end up at?[/quote]
I agree with the excellent answers you’ve gotten above.

I’d see where you are and where you can be with the thyroid first. It could be that that is your entire issue.

Also agreed on needing LH/FSH next time.

I have been talking Kelp tablets and iodine for a little of a week now. Started taking 800-1000 mcg/day have dropped it down to 400-600 mcg/day. I have also been using the Adrogel for 2 weeks.

After 2-3 days I feel much, much better. The last couple of mornings my temps have been 97.4 and afternoon at 98.5. My sleep has been better. I feel like I have more energy and I can make it through my workouts without crashing. I have also noticed that my muscles feel “harder”. I did not go the TRT clinic since I wanted to try and get things with the Thyroid workout.

How long after starting the iodine should I wait to have everything tested agian?

So have not posted in a while but several things have changed. I switched doctors and he took me off Androgel and put me on Test Cyp injections. I feel so much better since switching from Androgel to shots. I have lost around 35lbs, gained some muscle and feel much better. I have been on the shots for around 1 year. Below is my currently injection schedule.

-Test Cyp 160 mg on Thursday @ 4:00 pm
-HCG 500 iu on Thursday @ 4:00 pm
-Amridex 0.25mg on Saturday morning (after my latest blood test he switched to 0.25mg on Friday afternoon and 0.25mg on Saturday afternoon)
-Levothyroxine 75 mcg every morning

OTC:
Fish oil, kelp, multivitamin, Vit D and ZMA.

I had blood tests done on 4/21/16 exactly 7 days post injection. Here are the results:

TSH, High Sensitivity: 2.19, range: 0.45-4.50 mU/L
Total Testosterone: 868, range: 336 : 250-1100 mg/dL
Prostate Specific Ag: 0.5, range : <=4.0 mg/mL
Hemoglobin: 15.6, range: 13.0-18.0 g/dl
Estradiol: 39.7, range: 8-43 pg/mL
Blood pressure: 112/61 (this has really dropped since being on TRT)
Pulse: 60 bpm.

When the test was taken I was on Amridex 0.25mg on Saturday morning. He switched me to 0.25mg on Friday afternoon and 0.25mg on Saturday afternoon. He would like to get my Estradiol down to around 30 pg/ml.

I did a consultation with another doctor today. She seemed very knowledgeable and nice to work with. She said that my last blood test the Test level look good but my Estradiol should be between 20-25 pg/ml and my TSH should be around 1 mu/l. She did not like my injection schedule and thought the HCG was way too low. She said that twice a week is a much better schedule. Below is what she would do for an injection schedule (it is close to what KSman recommends):

-Test Cyp 50 mg twice a week (adjust to stay in the 800-900 mg/dl)
-HCG 600 iu twice a week
-Amridex 0.25mg twice a week (adjust to get to 20-25 pg/ml)
-Levothyroxine 75 mcg every morning or switch another pill that is T4 and T3.

Currently it cost me $80 a month for shots and blood tests, but I have to go to his office once a week for the shots (about 15 minutes out of the way for me). The rest is covered by my insurance. The new doctor will let me do at home shots twice a week after the first shot. All the supplies will be shipped to me. BUT they don’t take insurance and it will cost around $300 a month. They will give me an itemized receipt and I can submit to my insurance to see if they will cover it.

Some questions, is it worth the extra $220 a month to switch to shots twice a week? Or should a maybe look at doing TRT on my own without a doctor and do shots twice a week? If I decide to do it without the doctor about how much does it cost per month to do TRT (including blood test)?

$300/month seems expensive. My meds cost $130 for 10 weeks worth. That includes 2000mg of T cyp, ten 1mg anastrozole tabs and 5,000iu of hcg and all the syringes.

Do you go through a doctor?

I get the prescriptions from a doctor but I get the meds from a pharmacy.

I need to find a doctor like that. This lady seems to recommend everything that I have read on this forum and others like it. The HCG is a little higher than what I have seen recommended 1200iu a week. The convienence of doing everything at home would be nice but $300 is steep compared to $80 I am paying now.

EDIT: Another option would be to stay on my current protocal for $80 and buy HCG online. The armidex he give me a bottle of pill every couple of months so I could up the dose to lower the E2.

Just so you know. Blood work for me is only covered once per year. Any other testing is out of pocket. So I spend about $400/yr on labs. So that adds another $33/month and that’s if I only do labs two other times in a year.

The stickies are now here: About the T Replacement Category - #2 by KSman

Please review again:
advice for new guys
protocol for injections
thyroid basics explained
finding a TRT doc

You can use body temperatures to refine thyroid med dosing

Suggest:
50mg T SELF-injected twice a week
0.5mg anastrozole at time of injections
250iu hCG SC EOD

Your E2 target is E2=22pg/ml which seems best for mood, energy, fat loss, fat patterns, libido.

You only need enough hCG to support your testes. More to crease more T is very much not cost effective. Too much can create high T–>E2 inside the testes and anastrozole cannot control that.

Get 500mg metformin and take twice a day. Quite effective and inexpensive at Walmart, Sam’s and probably some other locations. No negative side effects most of the time and many good positive heath effects other that improving insulin sensitivity.

Start getting wise on foods that are appropriate for type II diabetes.

Androgel was probably not working because of your thyroid problems.

The $80 per month I am paying now covers everything, med, labs. I just have to go to the doc office every week and he will only let me do shots once a week.

The new doctor the $300 covers everything also but it is pricey.

Your doctor doesn’t happen to be in Phoenix.

KSman

I have read the stickies multiple times. I am mainly trying to do everything through a doctor. My job has a high level of government security clearance and if I were to get caught with a class III drug I would loss that and probably my job.

This new doctor seems to want to put everything in line with what you are saying but $300 per month is pricey.

I will look into metformin, especially since Type 2 runs in the family.

Nope, Nashville, TN.

Nashtide,

I did a search looking for doctor recommendations in the Nashville area.

I live about a hour away in Hopkinsville, KY. Would you mind pointing me in the right direction. I appreciate it!