T Nation

TRT, Thyroid or All of the Above?

I have not started TRT yet but was recently written a protocol by a urologist. I first went to my Dr about the issues
(issues listed below in the history section) and he was the standard “labs are in normal ranges” . After reading many posts
on these forums I decided to go through a HRT clinic/program for evaluation. The Dr I spoke to was over the phone after they
had another set of BW pulled.

He gave me a protocol of Test 100 per week, HCG 350 X 3 per week and AI 0.5 mg x 1 per week. I have not received
it yet and still on the fence about starting it. My concerns are related to Higher LH and FSH in my two different lab
panels by each Doctor and the possibility that I may be hypothyroid.

My TSH seems to be a bit high and fT3, fT4 may not be optimal from what I have read on this site. So my concern
was that hypothyroidism could be the culprit for my symptoms. I started taking temps daily and listed them below in Hx.
I also saw many time a request to check ferritin levels so I did that at discounted labs. It was 429 ng/ml (range 30-400).
So my concern and questions are what do you experienced guys and @KSman to see what I am not seeing? Can this be related to T or
thyroid or both? Ill post pics of both labs below. Prior to my two most recent BW labs I had some basic ones drawn
during a routine physical in 11/16 and the TT was 521ng/dl (250-1100), FT 106.2pg/ml (35-155) ,TSH 3.90 mU/L (0.45-4.50).
These were the only labs from that BW that are in the sticky requests.

Age: 39
Height: 5’ 10”
Weight: 240 Lbs
Waist: 38”

Body & facial hair:
I have thick coarse facial hair and shave daily. I have always been hairy on most of my body but not
extremely thick. I have started thinning in what looks to be normal male pattern hair loss.

Hair growth as a teen:
Growth was normal but did have facial hair earlier than most teens I was around. Body hair seemed
to be normal for a teen and in my early twenties it was pretty much everywhere. Still is. Less in lower
legs over the last 5 years or so.

Testes ache or hurt: No

My moods are pretty steady most of the time but I do get very irritable and grumpy. My patience
seems to be short also. These episodes are more often over the last few years.

Libido: I would say it has definitely decreased over the last 2-3 years. Not terribly low as I still have increases
at times but definitely not what it was in my early thirties.

Get cold easily: Not really. On occasion I can feel chilly but normally Im hot and sweaty. My girlfriend states
that my hands and feet feel very cold to her often even though I usually can’t tell myself.

Dry skin / brittle nails:
Yes I frequently have dry skin (if Im not sweaty). Without the use of lotion it is especially dry on my
extremities. I will go through phases where my skin will be quite oily too. Nails do seem normal to me.

Use iodine salt: No

Exposure to chemicals: On occasion due to my job. FD.

Ever use hair loss drugs: No

Rx: Phentermine 37.5mg, Ambien 10mg

Mornings 97.6 (lowest and only a few times)) - 97.7 and 97.8 is where Im at the most.
Waking temp 98.0 - 98.7. I carry a thermometer with me to check through out the day.

General energy levels:
Always struggling to get moving and motivated. Major energy decline over the last 3-4 years. I have always
been very active and regularly exercising. So this change is difficult and very frustrating trying to break away from.

Difficulty gaining muscle:
Yes. I seem to have kept some decent muscle in my extremities but gaining seems to be impossible now.

Difficulty losing weight:
Yes. I find it very difficult and that is with daily activity and exercise. Seems like any and all effort comes without
results now.

General diet:
Caloric intake is approximately 2200 - 2800. Frequently miss breakfast and drink coffee. Lunches are almost
always a salad when I am at work. Snacks most of the time are bananas or rice crackers with hummus. Dinner is
usually the largest meal of the day for me.

These are the main issues I deal with causing me concern. Concentration has significantly become more difficult.
I feel very foggy and focusing is more of a chore and my memory seems shot. My drive is lacking and just to get
going is a chore. These are all symptoms that have started and worsened over the last few years.

General health:
Good.Other than the specific symptoms I have described I have not had any other known heath problems.
Had a doctor diagnose me with generalized hyperhydrosis when I was 20. Meaningless to most but in my studies of
generalized hyperhydrosis it is normally a secondary symptom related to another underlying issue. My guess is something
hormone related.

Number of recent antibiotic Tx: None

Chest size/gyno?/chest sensitivity?: 48 - 50. I carry fat in my chest but doesn’t seem to be gyno. No chest sensitivity.

Trouble urinating or awareness of prostate:
No other than the occasional stage fright. No awareness of the prostate.

Morning erections:
Yes I can still have them but they seem to come in phases. Sometimes consistent and then other times completely absent.

Ability to retain erection:
Yes but occasionally I experience difficulty or weakening maintaining one.

Current supplements:
Hammer Nutrition Eduralytes. Due to extreme sweating I find myself getting cramps and weakness during work incidents and
during/after heavier workouts.

Normal sleep patterns:
No. At work I can be woken up during the night due to incidents. If not being awoken from incidents. I will wake up multiple
times a night while at home and rarely will I experience a full night of sleep.

I don’t take any iodine and salt has always been as needed for me. No supplements and vitamins currently other than the
electrolytes I use for the sweating and cramping.

Thanks for taking a look fellas.

your free FREE T levels are excellent. if you are getting morning erections most of the time and have a decent libido, you do NOT need T replacement.
as we get older, we don’t get as sexually stimulated. you seen fine and I envy your T levels.

Thank you for taking a look. Well that’s where I agree and what has me concerned. I do have the prescription for TRT but libido and erections are still present enough. I do have these other symptoms listed in original post like extreme brain fog, motivation lacking, energy less and tired all the time. Clearly there are similar symptoms to low T but can be driven from something else. I wondered about my E2 levels and also thyroid levels. Is it possible that an AI would be used if E2 is high and not being in Trt?

If available would you mind taking a peak at my post for opinion and recommendations. @KSman

Cramps are a good sign of magnesium deficiency and most are deficient without any complicating factors. Get ZMA from the Biotest store on this sight. Take 1 cap in AM and two at night. Later if things are improved, you could try two caps per day. When you take minerals like this, your body can only absorb so much from a dose.

You absolutely need iodized salt and should not use non-iodized. There are vitamins with 150mcg iodine and 200mcg selenium.

FD: This implies possible contamination from fire retardants. Some contain antimony, other bromides. Do you need to wear fire retardant pants through whole shift. Sweating increases exposure.

Take 25mg DHEA every day with a meal that has less fiber and more fats.

Increase cholesterol with dietary choices, try to get near 180 total.

Please check oral body temperatures as suggested below.
Some concern with fT3 above mid-range, could be some stress effects on adrenals.

Thyroid lab ranges are mostly useless.
TSH should be close to 1.0

Ferritin: Mens’ bodys hoard iron. Please avoid iron fortified foods: rice, pasta, flour, breads, cereals - read the labels.

You are somewhat primary hypogonadism.

E2=30 is not good with your mid-range FT. Lowering E2 could be helpful for your mental state, but has no advantage re LH/FSH as these are already high.

Low DHEA might possibly be rate limiting DHEA–>T inside the testes, but something else is probably wrong with your testes.

self inject T cyp/eth 50mg twice a week, subq, not IM, #29 1/2" 0.5ml insulin syringes
you will need 0.5mg anastrozole twice a week at time of injections as you are already well above the therapeutic target of E2=22pg/ml
hCG probably better every other day, 3.5x per day

??? Waking temp 98.0 - 98.7. ???

Snacks are to carb rich, hummus is not bad.

History suggests Vit-D deficiency. Test Vit-D25 later on. Find 5,000iu Vit-D3 tiny oil based capsules and take 25,000 first 5 days and 5,000iu thereafter. Take with a low fiber higher fat meal.

Get a high potency B-complex multi-vit with trace elements with 150mcg iodine and 200mcg selenium. [Might resolve high RDW.]

Have you had a doc examine your testes for vascular abnormalities etc?
Noted not aching.

Good observation by GF re cold hands and feet. But sweating can easily account for that.

Less hair on lower legs is reflecting lower T levels.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Holy crap thank you @KSman for this in depth look into my case. Very much appreciated!

No I haven’t. But they seem to be tighter and closer to the body more often hen not. There are periods of time when they appear full and away from the body.

Those were afternoon temps. From 1-2pm. Mornings waking up while still in bed were 97.6-97.8. I carry the thermometer with me to check frequently.

Again thank you Sir for you’re response.