TRT and Thyroid

I made another thread detailing my struggles with TRT. I’m actually on my first week of no TRT and HCG only in order to get my fertility back. But in reading some on this site I noticed non-absorption of Androgel may indidicate a thyroid problem. I always have cold hands and feet, am cold natured, and have below average temps. I do not eat salt on anything, and my multivitamin (Orange Triad) has 255 mcg of iodine.

I had blood work on 7/7/11 which showed free T3 at 3.7 - range (2.0-4.4). Total T3 at 1.18 - range (.80-2.00). Free T4 at 1.55 - range (.91-1.70). Total T4 at 8.04 - range (4.60-12) and TSH at 2.180 - range (.270-4.200). Does this seem like thyroid could be an issue and be related to my low T levels? Thank you very much for any help you can give me.

I’m not real up on the thyroid side, perhaps one of the other guys will chime in…but I’d certainly persue this avenue as a potential issue.

Maybe try Dr. Mariano;s site or forum for this question?

Its above my pay grade, but Im almost certain one of my docs explained how my thyroid was related to my Test and overall hormone issues…

I was on thyroid for a while, then thyroid and cortisol, then off cortisol slowly, then off thyroid slowly…but still taking Test, HCG And GH…

For a while I really needed the thyroid and cortisol though…

Read the comments about thyroid, iodine, salt and body temps in the advice for new guys sticky. Check your body temperatures and report the actual numbers. If low, you can check and see if iodoral makes you feel better and increased body temperature. If iodoral does not make any changes, then the problem may not be an iodine deficiency.

If T3 and T4 are perfect, temperatures can still be low if fT3 is been blocked by rT3. Adrenal fatigue increases rT3, and some other issues such as extreme dieting/starvation or over-training.

So I’ve been checking my temps at 10am when I wake up and 3pm for the past few days. They are as follows:

10/23 - 3pm - 97.3
10/24 - 10am - 96.9
10/24 - 3pm - 95.8!!!
10/25 - 10am - 96.9
10/25 - 3pm - 96.9

Pretty low, huh? Outside of 255mcg of Iodine in Orange Triad I’m not supplementing any additional. I eat anywhere from 2400 to 2900 calories depending on training. Slow cardio 30 minutes two or three times a week. Four day split, pyramided up to a max set. Nothing I would think would lead to overtraining. Lost over 80 lbs four years ago and have trying to gain muscle and get the last little bit of fat off the stomach, love handles, and chest ever since.

My iodine deficiency and outcome.

I actually read that thread and it is one of the things that really got me thinking about this whole deal. So what dose are you currently taking of the Iodoral? My TSH, T3, and T4 were all in range, but I know that the ranges are often bullshit. I am assuming you would supplement and monitor temps to determine the effectiveness?

Yes, body temps can be a useful dosing guide. If body temps improve, that seems to be indicating an iodine deficiency. I currently take a maintenance dose, 6mg every week or so.

Thanks for your help. I eat a lot of fermented foods and probiotic rich foods in order to keep my gut healthy. You think the Iodoral will screw it up too bad?

When I was taking 50mg per day, after a while my digestion was affected as the iodine started to kill the bacterial that were vulnerable. I was then feeling a lot better and took a break for a few days and resumed at 12mg/day. Your iodine replenishment phase does not take long, then you are back to normal.

Hey KSman, I was just thinking (and that’s a bad sign), but if the T gel shut down my LH/FSH completely and caused my fertility to go super low, wouldn’t that be a sign that absorption was not an issue and that my body was getting the T through the skin? The level was still low (371), but it obviously affected my other values.

You have not posted any info suggesting a fertility problem. Low T can make sex difficult, not the same as a low sperm count. TRT will for almost all guys, shrink the testes and fertility then can be a problem. hCG will keep the testes in form, but then sperm counts can be lower as there is no FSH, although it is believed that hCG weakly stimulates FSH receptors. If you need to pop a baby and sperm counts are not sufficient, you can take nolvadex for a while, dropping hCG. Then LH and FSH will typically come on stream.

Some convert T–E2 strongly in there skin, less to get into circulation.

I do not know what the effect is on LH/FSH for hypothroidic non-absorbers. We do know that some of these have lower T when applying, suggesting that HPTA shutdown is happening. E2 could do that.

Androgel and other similar weak T products that need to be spread over a large area of skin have the highest T–>E2 rates, because the large area exposes a lot of aromatase in the skin to high concentrations of T. And when guys apply small volumes of 10-15% T creams to small skin areas that there the E2 levels are lower. We have seen that in guys making that switch. I injections avoid the high local T concentration effects in the skin. Note that AI drugs can have difficulty managing T–>E2 in the skin as the competitive drugs cannot compete with the local super concentrations of T.

Note that elevated E2 will increase SHBG and that lowers FT, and for some FT is a lot lower. And then the E2:FT ratio has become very adverse and with that estrogen dominance, some feel a much worse.

Sorry I try to be as detailed as possible, but also keep things tidy so I don’t get responsed asking for cliffs.

I am off TRT for six weeks and injecting 500iu HCG twice a week because my LH and FSH were almost zero and a fertility test came back very low. I have Nolva laying around, but I’m not currently taking it. You think that would be beneficial to add in to recover fertility? What dose?

The doc didn’t test E2 at the last blood draw even though I asked them to run everything. I’m going to insist when I go back after this HCG run. If my levels didn’t respond to the HCG and I need to permanently do TRT, I’m going to switch to the protocol you laid out in the stickies.

I just thought with my low test numbers even on the gel, my temps, and my cold extremities, I may be looking at a thyroid issue.

Depending on age and other factors, hCG alone may not yield useful T levels. However the testes will be supported in terms of size, firmness and fertility to some degree. Nolvadex can do the same, but the resulting FSH will support sperm production to a greater degree.

You do not combine hCG and a SERM as the LH receptors do not react well to overload. No one has attempted a combo of 1/2 doses of each. Some will to T+AI+hCG and switch SERM for hCG a few times per year hoping that that will preserve fertility in the long run and that switch should done when trying to conceive if there are known sperm count concerns.

Many get benefits from 1/2 doses of SERMs. Again, do not do add SERM to hCG, switch.

hCG will keep LH and FSH low, no increase, only increased testicular function.

T+hCG or hCG alone will have the same outcome in terms of fertility. With the T you would be having more sex and that is certainly a factor if you are trying to conceive now. And E2 management has a strong effect on libido and performance.

Yeah, sex isn’t a problem. I normally have sex or masturbate once a day. Never more than two days. Thanks for the info about the HCG and the SERM though. I definitely won’t combine them. I have already noticed in two weeks a significant change in my testicles. I will definitely keep the HCG in with the T when I start back up. But I’ll try to get more complete bloodwork and post back when I have current E2 levels.

Got labs done Monday after 6 weeks of HCG at 500ius 2x a week and about two weeks since my last shot. So roughly 8 weeks since ceasing Androgel usage. I asked for a complete thyroid panel, and this is what I got. Really interested to see what advice KSMan can give me.

TSH - 2.7 (too high? shooting for closer to 1? Temps averaging mid-96s/low 97s. waiting to get these numbers back before starting iodine supplementation.)
T4 - 7.9
T3 Uptake - 35 (what is this?)
Free thyroxine index - 2.8 (what is this?)

Testosterone was at 528 up from 371 on Androgel with just the HCG usage. Didn’t notice any adverse changes in mood. Doc said he would give me a prescription for the injections protocol (50mg 2x week subQ, HCG 250iu 2x week subQ, and anastrozole), but I’m wondering if I even need it. Free T was 15.4. Estradiol was 30.2 For the past couple weeks I have been taking exemestane at 12.5mg EOD on advice from someone else and that was during the blood tests.

Other numbers were good with BUN being a little high, creatinine good, cholesterol at 177, HDL 68, trig 69, etc.

Thoughts on the numbers?

HDL=68 is really good.

You could try anastrozole. But your dose will be starting at 0.5 mg/week and that is not doable by splitting pills. So you will need to make or purchase a RC product to be able to dispense by the drop.

Exemestane is not effective or perhaps your E2 would have been much higher without. If IA’s will not work, hCG dose is too high.

Yes, you may be OK with hCG alone. Would rather see more frequent doses.

But hCG is hard to travel with. There are two options:

  • use T injections when you travel, vials and syringes
  • use Nolvadex when you travel, take a pill

If DHEA-S is lowish, take 25mg/day as that may improve T levels if DHEA rate limited now.

Tyroid: - please [edit] the above and add lab ranges

TSH is getting high and increased
T4 is near mid range no real change
Temperatures indicate that there is a problem.
Assuming that nothing has change since opening post.
? iodine ?
Have you seen the new “thyroid basics” sticky?

Added ranges in previous post. I have read the new sticky and found it very helpful. I will be starting iodine supplementation based on low temps, just wanted to get these numbers back first.

Nothing has changed since the opening post other than the addition of the exemestane, and the cessation of HCG after the six week protocol.

My comment about quitting TRT all together was including no more HCG. I’m just wondering if any of this has been worth it at this point, or if maintaining a level naturally in the 500s is possible or optimal. I just never really felt any benefit to it. But again that coud be because I just haven’t been treated properly. I have no problem doing the TRT per the protocol in the stickies if it will be better for me in the long term.

I’m not seeing ranges in the previous post.

TSH - 2.710 range = .450-4.500
T4 - 7.9 range = 4.5-12.0
T3 Uptake - 35 range = 24-39
Free Thyroxine Index - 2.8 range = 1.2-4.9

With E2=30, that would block some of the benefits. If you do not feel right, thyroid problems could be the reason. Stay on your T program.