T Nation

TRT Not Working. Thyroid Function? Bloodwork Results


I am looking for blood work interpretation for my thyroid function (see results below).
@Ksman … I would be very grateful for your input… I have been reading through your posts, thank you for all the information you have provided to this site.

Thyroid Function

FREE THYROXINE 13.8pmol/L (12.00 - 22.00)
TOTAL THYROXINE(T4) 60.9nmol/L (59.00 - 154.00)
FREE T3 5.45pmol/L (3.10 - 6.80)
THYROGLOBULIN ANTIBODY <10 IU/mL (0.00 - 115.00)

Here is my background… I am 40 years of age, 6ft 2” and weigh 98 kilos with a fairly lean muscular build. I am a regular gym goer and have cycled AAS since my early twenties. Due to my anabolic steroid use, I have recently started TRT which I am still adjusting for best results (two subq injections per week test enanthate + HCG + Arimidex). I am from the UK and would have no idea of my iodine levels although there is a blood test available for this. I switched to a low sodium salt many years ago which I think could have been around the same time that I noticed a dramatic drop in sex drive and tested ‘low’ for testosterone (12 nmol/L) Ref range (9-29) but I put this down to my error of running a Winstrol Depot only cycle.

Before starting TRT, I had blood work done one year after ceasing all steroids/pct meds and to list only testosterone and thyroid the results were as follows: (blood work drawn one year ago).

Testosterone 12nmol/L (9-29)
LH 5.0 iu/L (1.0-10.0)
FSH 9.0 iu/L (1.0-12.0)
E2 <18 pmol/L (95-223)
Prolactin 264 mU/L (86-324)

TSH 2.3 mu/L (0.30-5.50)
Free T4 16pmol/L (10-22)

I have taken several body temperatures recorded very close to 37C (98.6 F). I have read on this forum generally mentioned by Ksman that optimal TSH level is around one… I am not experiencing any symptoms other than a low sex drive (which I believe is due to low test) and poor injury heeling (muscular and bone).

Any advice would be really appreciated…

Personally I’d look at symptoms first and bloods second. No point looking for something that isn’t there.
I have had similar TSH for years (in the 4s) and similar low range T4. My temps have been 95.6 to 96 so yours sound perfectly normal.
I supplement with lugols iodine now and in the last 10months gone from nearly bald legs and back to now hairy legs and back. However I still had no energy and T4 didn’t change. Libido has been zero for two years now.

But in just two weeks on TRT my depression is lifting and I feel more awake and i’ve had strong libido urge (only for one day) but fingers crossed this continues.

My total T was around 450 but free T never above 0.3.
GP mentioned he may have to put me on T4 if the TRT doesn’t bring things back to normal.

@ksman will I’m sure be more helpful but that’s just my take on my similar situation (i’m 48)

It not sure if i’m allowed to post which private GP i’m using but I guess people can PM me or let me know.


Thank you for your reply Pete… I hope your symptoms improve. In regards to my blood work, I have read that low levels of T4 and free T4 but normal to high T3 can mean the the Thyroid is working extra hard to convert the T4 into T3 which is Hypothyroidism. What I find confusing is how different labs and different countries can have different reference ranges. Some say a TSH level above 2 is hypothyoridism but like you mentioned, if there are no symptoms there is no point chasing numbers. Its wishfull thinking but I have read that hypothyroidism can cause low testosterone output and maybe that is why I am not making a full recovery of my test levels. Altough my body temperatures are good, I would be interested to know if supplementing with iodine and selenium would be of any benifit to me. This is where I am hoping @KSman can advise.

P.S are you in the UK? I may PM you in regards to your private GP…

All the best…

Yes i’m In the uk so PM me for private GP.

My GP did say that he may well find he has to sort my thyroid as well, but wanted to see how the testosterone goes.

I went with a combined HCG and test with Anastrozole (aromatase inhibitor AI) protocol.
They do offer just T and AI protocols as well.
Wanted to see how well I could produce testosterone on my own.

I did try T4 but not with bloods so I was randomly stabbing in the dark. My mother and sister are both hypothyroid so I suspect I may have some issues he.

I made my own Lugols iodine drops and I was shocked how quickly the hair grew back and continues to do so. This was a recommendation from @KSman, not sure it changed my Thyroid yet? Bloods showed an initial spike of TSH, up to 6 but it’s come back down again after 9months to the 4s again. Cannot day I have any more energy though.

What I can say is that the two weeks of TRT have removed a vail of depression and brain fog, I am more relaxed and find it easier to have a laugh and joke and cope with my testosterone filled young son. Before I would find everything he did and my wife totally irritating and would blow my top at the slightest thing.

Lidibo seems to be related to my estrogen and prolactin levels. I had a brief rush within days of starting but now it’s lurking in the background. Which is better that the zero I had before.

I’m hoping my 6week bloods will show i’ve Either gone too low or still remain too high on E2 (estrogen)

I’m certainly not prepared to let the NHS sort me out. Bodybuilders know more about how these drugs work than any GP and no one knows your body like you do.
I never abused drugs when I was young and I can only attribute the problem with maybe the vasectomy aged 35, or just bad luck.
Anyway, get back to me if you need any contacts in UK.

So body temps for the world should now match yours?

In UK iodized salt is not in most stores, but in some. You are expected to get your iodine from dairy foods and sea food. Organic milks has less iodine.

fT3 is good and so are body temps, your body is compensating well. fT4 is well below midrange, more iodine and selenium would be helpful. Note that higher iodine supplement doses are expected to cause higher TSH lab results and the results are then not actionable. Thyroid antibodies indicate no issues from inflammation and selenium assumed adequate - so far.

Sodium does not cause high blood pressure. The hysteria there is strange. When arterial damage causes high blood pressure, lower sodium reduces blood volume which is useful compensation, but blaming salt is wrong. When blood volume is reduced and BP reduced, you still have reduced general circulation, the problem is still there.

Hello @KSman Ksman,

Thank you for replying to my post and apologies for not doing this sooner. I would like to ask for some further advice if I may…

Would my TSH levels or low end level T4 be impeding my natural testosterone recovery post AAS use?

Would you consider it important to treat my low end T4 level?

You mention TSH would rise with iodine supplementation, would this be permanent or would TSH fall back again after a period of time?

Many Thanks

I do not think that lower T would cause thyroid problems, women are one example of lower T levels.

Low thyroid function appears to have some effect on all systems to some extent. But correcting thyroid status often does not create major changes to low-T.

If one has an uncomplicated problem with iodine deficiency, after correcting that, maintenance amounts of iodine and selenium will provide on going benefits. TSH increases during higher dose iodine is transient and the only harm it that is the fact that TSH labs at that time have no usefulness and need to be disregarded.

With good fT3 and oral body temperatures there is really nothing wrong. Lower fT4 might be calling for more iodine if your intake has been lower.

You may not need large amounts of iodine.

Thank you very much @KSman for taking the time to reply. I had more blood work done recently (see attached) as I am still trying to dial in my trt… I am now on test e 125mg per week split in to two equal doses taken every 3.5 days coupled with 200iu HCG eod… I am not using any AI… My doctor thinks that my numbers are good and that I should give the protocol more time and look at improving other areas such as stress and sleep. (The E2 is non sensitive). I have noticed that both Ft4 and Ft3 is now both low end of normal and my TSH has slightly risen. I used to take a selenium supplement but stopped weeks before this blood work was taken (see below) as I did not want to take anything that could interrupt my TRT treatment whilst still finding the correct protocol. However, after this bloodwork (see below) I have now recently started taking a multivitamin supplement which contains Iodine and Selenium after reading you’re sticky on thyroid. My question is… Could my low ft3 and low ft4 be having a negative impact on my trt treatment? I have yet to feel any benefit from my current protocol.

Hey man… Can you update us ? I’m in similar situation as you.

I’m still no better… I’ve just had bloodwork back showing boarder line normal t3:rt3… I am currently on Levothyroxine… I am going to start a new post on this subject.