Low T / high normal TSH, low fT3&4 / low normal AM cortisol...what's causing what?

[Fr8man]

So I've retested some tests at a different lab and there are many things that are out of range.

I don't know where to start, or how to go about with treatment, or what is causing what, or if there is a direct connection between any of them and one of them is throwing the others off.

I don't have a doctor that is learned in this anywhere around me. I am overseas. Not in the US.

I did the tests as a pre-TRT reference. But now I'm not sure how to proceed. I would love to fix the low testosterone issue without having to resort to TRT. So I am wondering if any of the things that are off is what's causing the low T. And if that's the case, then which one? And why is it off and how to treat it (not patch it)?

Or is it the low T that is causing everything else to go out of whack?



Stats:
37 / m / 248 lb / 6'4 / %26 bf

Low T has been the case since I found out 7 years ago.

 

[Systemlord]

The truth is most men never really know why testosterone is low, it is just low and requires TRT, the other men have a reason which is testicular failure or some type of pituitary abnormality like a tumor secreting prolactin.

I once read a paper on bilirubin clearance and thyroid function, the participating patients that had their thyroid hormones suppressed showed higher bilirubin levels versus those who had hyperthyroidism induced which had very fast clearance rates and very low bilirubin. It appears thyroid function plays a big part in the clearance of bilirubin among other things.

The low creatinine could because of low muscle mass. The hypothyroidism typically is not responsible for low testosterone.

The ESR could indicate cancerous tumors and autoimmune diseases, the high lymphocytes indicates an infection or other inflammatory condition is present. Low testosterone can increase inflammation which is one reason men with low testosterone are more likely to later develop diabetes.

You can try treating the thyroid first and see if you are able to get testosterone to increase, if not it's not for a lack of trying. Then you would need to start TRT and by then your thyroid will be ready to metabolize testosterone in the liver because TRT cannot work when there are thyroid problems.

 

[Fr8man]

The truth is most men never really know why testosterone is low, it is just low and requires TRT, the other men have a reason which is testicular failure or some type of pituitary abnormality like a tumor secreting prolactin.

I once read a paper on bilirubin clearance and thyroid function, the participating patients that had their thyroid hormones suppressed showed higher bilirubin levels versus those who had hyperthyroidism induced which had very fast clearance rates and very low bilirubin. It appears thyroid function plays a big part in the clearance of bilirubin among other things.

The low creatinine could because of low muscle mass. The hypothyroidism typically is not responsible for low testosterone.

The ESR could indicate cancerous tumors and autoimmune diseases, the high lymphocytes indicates an infection or other inflammatory condition is present. Low testosterone can increase inflammation which is one reason men with low testosterone are more likely to later develop diabetes.

You can try treating the thyroid first and see if you are able to get testosterone to increase, if not it's not for a lack of trying. Then you would need to start TRT and by then your thyroid will be ready to metabolize testosterone in the liver because TRT cannot work when there are thyroid problems.

Appreciate your input Systemlord.
How do you suggest I go about treating my specific thyroid condition?

 

[dnfuss]

So I've retested some tests at a different lab and there are many things that are out of range.

I don't know where to start, or how to go about with treatment, or what is causing what, or if there is a direct connection between any of them and one of them is throwing the others off.

I don't have a doctor that is learned in this anywhere around me. I am overseas. Not in the US.

I did the tests as a pre-TRT reference. But now I'm not sure how to proceed. I would love to fix the low testosterone issue without having to resort to TRT. So I am wondering if any of the things that are off is what's causing the low T. And if that's the case, then which one? And why is it off and how to treat it (not patch it)?

Or is it the low T that is causing everything else to go out of whack?



Stats:
37 / m / 248 lb / 6'4 / %26 bf

Low T has been the case since I found out 7 years ago.

Before starting TRT, it would make sense first to treat your hypothyroidism. It is very difficult to find competent doctors for this in the U.S. I have no idea if this is also the case where you are, but it wouldn't surprise me were it so.

Typical doctor in the U.S. would start patients on Synthroid (T4-only). Works for some, did not for me. Many who are unsuccessful using T4-only then try Cytomel (T3-only), although harder to find a doctor willing to prescribe it. Some on this site swear by it, but I tried it and never could get the dosage right for me. Many patients have good results on some form of NDT (naturally dessicated thyroid; several prescription-only products and some overseas OTCs). That is what I am on now, and I'm quite satisfied with my current protocol. There are also patients who find success with some combination of the above therapies (Synthroid + Cytomel, NDT + Cytomel, etc.).

In addition to this site, which has on it many members who are far more expert than I am on these issues, a good starting point for information on all things thyroid-related is Tired Thyroid.

You may also wish to address the results of your fasting (I assume) glucose and HgbA1c tests. Neither is definitive in and of itself, but repeated panels with similar results would suggest the early stages of mild diabetes (pre-diabetes) and indicate further testing.