Newbie with a couple blood tests over two months or so.

[Corsair84]

Started out at a mens health clinic and got prescribed 1500ml HCG x3 a week but pushing back a little because of the cost of 2 5000 vials per month. Not undoable but not inexpensive either. Reason for HCG is wanting to have kids in the next year or so.. (I'm not against test cyp w/ hcg)

35 year old male w/ no diabetes 6'0 at 235lbs.
Would love some insight, i've done some research but still new in figuring all this out.

 

[Systemlord]

TSH is too high, needs to be <2.5 preferably closer to 1.0. When the highly sensitive TSH testing came out it was found that 95% of the population has a TSH <1.5.

Free thyroid hormones need testing, fT4, fT3, rT3 and both antibodies. There are many with thyroid disease >3.0. T4 is on the higher end which means your thyroid is producing a lot of thyroid hormone which is surprising because TSH is elevated indicating the pituitary gland is detecting less than optimal free thyroid hormones.

You may in fact have a conversion disorder having unbalanced free thyroid hormones. If having estrogen sides on HCG, try injecting smaller doses daily or EOD.

When you are ready for TRT and if hypothyroidism can't explain low SHBG, you may need very frequent dosing since SHBG is low.

TSH and reference ranges for thyroid hormones

Optimal V.S Normal Thyroid Hormones

 

[Corsair84]

Good info!

I currently haven't started any protocol if i didn't make mention of that, I'm almost about to.

So how does one lower TSH?

The frustrating part is I specifically requested a full thyroid panel and supposedly 'got it' but evidently not.

Can you explain more about conversion disorder?

What is considered very frequent doses?

I'll read those links and if they explain the questions above I apologize.

 

[fifty]

1500 3x/wk? I would start with 500 3x/wk or 250iu daily.

 

[Corsair84]

Thats what I thought my doc was saying when he said he wanted to do mono therapy with HCG.. After I left and saw the med request I sent him a message back saying uh.. what?

 

[Systemlord]

So how does one lower TSH?

Depending on your thyroid panel, if rT3 were elevated and fT3 was low, T3 only medicine would be the correct treatment, but understand there is not much you can do naturally to reduce TSH other than thyroid treatment.

An elevated TSH is a sign the thyroid isn't getting the job done, but in your case it is producing more than enough thyroid hormones, only I believe free thyroid hormones are out of balance.

Ideally you want fT3 midrange or preferably higher, rT3 <15 ng/dL. One test may not be enough to catch the thyroid red handed, blood testing is a snapshot in time of a target that is always on the move.

The frustrating part is I specifically requested a full thyroid panel and supposedly 'got it' but evidently not.

You may have put your trust and care in the wrong hands, they probably heard your request and never had any intention of following through, in other words they blew you off. If they don't understand why they should order a full thyroid panel, then this is an indication they don't know how to play this hormone game very well.

Your TSH should have set off alarms like, "this guys TSH is elevated, we need to take a closer look", but that didn't happen because they probably don't even know how to interpret the labs.

This clinic probably isn't in this for the right reasons, the patient, they are selling product nothing more. Perhaps they don't know what they doing and are trying their best. With that said you should never inject more than 500 iu at one time. A more appropriate HCG dosing is 100-150 daily, 250-300 EOD, 350-500 twice weekly.

Can you explain more about conversion disorder?

Let's take what we know about free thyroid hormones, fT3 is the only active thyroid hormone, it increases metabolism and energy in every cell in the body, it provides energy to every organ, rT3 can block fT3 since it competes for the same receptor, then you get tired and your metabolic process slows.

What is considered very frequent doses?

I consider very frequent dosing either daily or EOD.

 

[Corsair84]

First thank you for the seriously thought out responses, very much appreciated.

In 10 days I have another appointment with a different Endo. and will request more bloodwork, so in your opinion what should be tested for a full picture?

Thankfully I get bloodwork through the VA so I'm at least not taking the hit and can request more frequent bloodwork if needed without going broke. That's great info on the thyroid, and stuff I definitely didn't know.

----

Thats the frustrating part is I left the VA's endo because the guy was 80 and no real knowledge, he said my labs looked fine and needed no treatment lol. Even I knew he was crazy.

So I found this new place and assumed it'd be better as its what they 'specialize' in, but after starting me on a mono therapy of HCG (which isn't bad), but not doing all the bloodwork I wanted them to do it's a bit disappointing. Specially when I requested a full thyroid check.

----

That's really interesting about conversion disorder, one of my main issues is feeling like a slug. I just have so little energy and I used to be the one that could just go go go with no coffee or breaks. Now I barely leave the house :/ unless I have to.

---

I'm honestly up for anything if I can get my shit under control even if its every day or EOD.

Again I appreciate your time in responding.

 

[Vince]

I agree with Systemlord. Before considering trt get a complete thyroid panel. TSH, free T4, free T3, reverse T3 and both antibodies. Once your thyroid levels are in the right range, then you can consider treating your testosterone issues, if still needed.

 

[Corsair84]

Is it possible a hypothyroid issue could tank my testosterone this much? Not a sarcastic remark I’m genuinely curious.

 

[Systemlord]

Is it possible a hypothyroid issue could tank my testosterone this much? Not a sarcastic remark I’m genuinely curious.

More often this is not the case.

 

[Corsair84]

Got a little bit more bloodwork to sleuth through..

Component
Your Value
Standard Range
SEX HORMONE BIND GLOB
12 nmol/L
10 - 57 nmol/L


Component
Your Value
Standard Range
LH
7.8 IU/L
IU/L

Component
Your Value
Standard Range
TESTOSTERONE
256 ng/dL
249 - 836 ng/dL

Component
Your Value
Standard Range
CORTISOL
4.5 ug/dl
2.5 - 19.5 ug/dl

Component
Your Value
Standard Range
TOTAL T3
115 ng/dL
80 - 200 ng/dL

Component
Your Value
Standard Range
T3 UPTAKE
30 %
22 - 35 %

Component
Your Value
Standard Range
THYROPEROXIDASE AB, S
0.3 IU/mL
<9.0 IU/mL

Component
Your Value
Standard Range
TSH
4.81 uIU/mL
0.34 - 5.00 uIU/mL

Component
Your Value
Standard Range
FREE T4
1.3 ng/dL
0.9 - 1.9 ng/dL

 

[Systemlord]

I see no rT3 testing, rT3 can negate a big portion of fT3 then increasing TSH. T3 is obsolete and not the active hormone and is best for diagnosing hyperthyroidism. A high rT3 would then block fT3 deactivating it and increasing TSH.

You seem to be making enough T3 and more than likely have a conversion disorder converting too much T4-->rT3 instead of fT3, the main active thyroid hormone.

Prolactin can't explain low testosterone, but the high LH can and you have primary hypogonadism which is testicular failure. Fertility may be at risk, just like TSH increases for thyroid stimulation, LH is the stimulating hormone for the testicles to produce testosterone.

Your pituitary gland is working perfectly, but your testicles and thyroid glands are not functioning correctly. I would expect to see a healthy individual with high normal LH to also have high normal testosterone which would show the signal is being sent to the testicles which are producing a sufficient amount of testosterone.

Cortisol is also low. I would also test IGF-1 levels because IGF-1 is directly linked to growth hormone.

If FSH is abnormally high, this indicates you may already be infertile.

Do you have FSH labs?

 

[Corsair84]

I tried, and its still supposedly coming? I asked specifically for those tests and even got into a fun argument with my doctor because he saw no reason and it'd be silly to test them. He said he put it in anyways though.

 

[Corsair84]

So I just had a semen analysis done, everything is above average across the board. The only FSH labs I have were from sept 12th and its the first attachment above.

 

[Systemlord]

So I just had a semen analysis done, everything is above average across the board. The only FSH labs I have were from sept 12th and its the first attachment above.

I was hoping you had FSH together at the same time as your high LH reading.

 

[Corsair84]

Not sure why he wouldn't have done that but he didn't :/ this was a new doc and 'real fun' to deal with

 

[Corsair84]

I have previous bloodwork with those two together multiple times though.

 

[Corsair84]

ComponentYour ValueStandard Range
T3 REVERSE 27 ng/dL10 - 24 ng/dL

 

[Systemlord]

You definitely have something strange going on.

ComponentYour ValueStandard Range
T3 REVERSE 27 ng/dL10 - 24 ng/dL

I'm not at all surprised, in fact I expected this result. A sizable portion of your fT3 is effectively neutralized and explains why TSH is elevated. There are numerous reasons why it could be elevated, it may or may not be correctable.

In any case if the cause is not found T3 only treatment is appropriate, otherwise any T4 added to treatment may in fact convert to rT3, not what you want.

 

[Corsair84]

Don't disagree there! Somethings going on for sure..

What are some of the numerous reasons? Cytomel treatment for t3?