Upcoming Defy appt - feeling tired

[Gianluca]

Canalesome, I don't think you actually eating enough calories, 2200 cal for a men like you is about your BMR, the calories you would need to lay down all day and support body function like breathing heart beats etc, that could have an impact on your energy levels and micro nutrient intake that eventually would cause nutrition deficiencies, keeping your calories too low or too high, based on your body requirement of it, can have an impact on your health, I will attach a link, Use it to see aprox how many calories your should be eating, try it, Ferritin at 50 is not optimal, men needs 80/120,

https://www.supertracker.usda.gov/bwp/index.html

Diet is fairly good. I aim for around 2200 cal; 40% carb, 35% protein, 25% fat. This varies some, but not much. I'm 6'2" and 205lbs. I used to be pretty lanky, but have watched what I eat while working out. Lift at gym 4-5 times a wk. I'm in bed by 10pm latest and alarm goes off at 5:30am. I struggle and eventually get up by 6:15am. I used to get up at 5-530 with no problem. No drugs for depression or anxiety.
Thanks for the input!

 

[Gianluca]

good advise from all, but what Vettester Chris said is what you should be focused on, in my opinion, my SHBG is lower than yours usually about 11, my FT was always high like 30/35 on 2 x or 3 x week shoot about 200mg weekly, I now do ED injection with 20mg and I try to focus my self on FT and not going more than 25/7 max, with the higher FT I would experience weird symptoms and water retention not due to E2, I think lower dose, lower FT, more frequency is = to higher SHBG that leads to better well being

How did you feel when your FT was at 18? very curios of that

by the way more FT more suppression of Pregnelonone, so if you are not aware of Pregnelonone do a research on the Forum and then talk to your Doc about it, that is related to Cortisol production, well being and better mood/sleep, many guys feel great when they start TRT then after 8 motnhs or so things go south due to suppression of Pregnelonone, very important

 

[Gianluca]

Chris very interesting your opinion of FT, I'm getting to understand this as well, I'm a low SHBG guy I was doing 2/3 injection x week 200mg tot and my FT always 30/35, that was probably a mistake as it would come along with weird symptoms elevated H&H water retention, it took me a while to realize this, that is probably unhealthy long term for sure, I'm trying to dial in with max 25/27 or FT now see how it goes,

If I understand correctly you actually feel your best with FT about 15/20?

Just to present another angle ... I think you are putting all your chips on Testosterone and TRT therapy as the road to complete wellness. Your test serum and free test can be optimized 5x over, but if other imbalances like your thyroid, adrenals, electrolytes/metabolic, etc.., are not in balance, no amount of testosterone is going to make the program optimal. I only say this because your thread is emphasized with "Feeling Tired", and the questions posed to the community are only focused on test, free test/SHBG, and E2.

To comment on the labs, I agree with the others, and you might find a more sustained wellness with aiming to get that Free Test down a bit (?). Not saying you will or that you need to do that, just saying in my own case, I find 15-20 to actually do quite well for the day-to-day routine of HRT. My sleep is better (that's essential), my E2 for the most part is usually stable; balanced and manageable without any AI, and obviously I feel good. However, I don't see too much benefit from any TRT protocol without a thyroid protocol, rest, donating blood and keeping my iron, HCG, ferritin in-line (carrier for hemochromatosis, so that's another story).

You're paying attention to your protocol and program, which is great, just consider giving it more of a "macro" focus when trying to achieve optimal wellness.

 

[Vettester Chris]

Chris very interesting your opinion of FT, I'm getting to understand this as well, I'm a low SHBG guy I was doing 2/3 injection x week 200mg tot and my FT always 30/35, that was probably a mistake as it would come along with weird symptoms elevated H&H water retention, it took me a while to realize this, that is probably unhealthy long term for sure, I'm trying to dial in with max 25/27 or FT now see how it goes,

If I understand correctly you actually feel your best with FT about 15/20?

Yes Bonetti, that tends to work for me, and again I base that on the fact that this is the zone (for me) where E2 isn't problematic, acne, or hypertension and other sides. Higher amounts can be fine for a short time, but my emphasis on HRT is to view it as a marathon, and it's only as strong as the balance of other components, i.e., thyroid, adrenals (other endocrine), electrolytes, metabolic, etc.

Especially the low SHBG crowd, where at 700ng/dl total serum, you have more actual bio-available free test than some of the guys at 1,000ng/dl or higher.

 

[Gianluca]

Cris, that is exactly the conclusion I come with, if there are present the side effects you have listed such as acne, Hypertension, water retention, it is probably too much Test, so I'm tailoring my dose according to these, guys just chase the symptoms, like a did for 3 years, when the dose is mostly the cause

great comment

Yes Bonetti, that tends to work for me, and again I base that on the fact that this is the zone (for me) where E2 isn't problematic, acne, or hypertension and other sides. Higher amounts can be fine for a short time, but my emphasis on HRT is to view it as a marathon, and it's only as strong as the balance of other components, i.e., thyroid, adrenals (other endocrine), electrolytes, metabolic, etc.

Especially the low SHBG crowd, where at 700ng/dl total serum, you have more actual bio-available free test than some of the guys at 1,000ng/dl or higher.

 

[stephenstrum]

I am a physician of 50 years duration and very much focused on male endocrinology as well as thyroid function. The TSH level of 1.29 is about as normal as you can get. it is not in the gray zone of high normal and no one I have ever encountered in the integrative medicine practice of men's health states that an optimal range is 0.5 to 1. Yes, you can order a free T3 and free T4 and simply calculate the T3:T4 ratio to see if optimal at about 25%. But I would be so "ballsy" as to bet my right testicle that your thyroid function tests (TFTs) are all quite normal.

 

[Amberlin]

Ask if you can take testosterone dose every other day & increase HCG to 250 every other day. In some people the therapeutic effects wear off quicker than in others. Defy is pretty good about letting us alter our own dose because no one knows your body as well as you do. Are you taking injections subQ or intra? If the latter, try subQ. The reason is that subQ tends to provide more linear absorption. Some men report their free T has increased via subQ vs intra. Of course, every person is different & results can vary.

 

[Vettester Chris]

I am a physician of 50 years duration and very much focused on male endocrinology as well as thyroid function. The TSH level of 1.29 is about as normal as you can get. it is not in the gray zone of high normal and no one I have ever encountered in the integrative medicine practice of men's health states that an optimal range is 0.5 to 1. Yes, you can order a free T3 and free T4 and simply calculate the T3:T4 ratio to see if optimal at about 25%. But I would be so "ballsy" as to bet my right testicle that your thyroid function tests (TFTs) are all quite normal.

Dr., thank you for your input. However, I might take you up on that bet. Agreed, OP posted a rather "normal" TSH level, but in the same paragraph it was posted that he has struggled with sub-adequate ferritin (51 is still low), and also suggesting low iron serum as well. If that stands, that could/ would possibly affect the efficacy or ability for T3 to reach the cells. With that scenario, I would presume that T3 pooling could exist, possibly keeping T3 serum elevated (but not productive), thus maybe inhibiting TRH/TSH activity through the negative feedback loop (?).

I would also think that Reverse T3 would be of interest, and also comparing its ratio with FT3 (FT3:RT3), as the body could tend to shift for a higher demand of RT3 if pooling and/or other factors are evident?

For these reasons and others, I personally find it difficult to use the TSH assay as the primary marker to make any assessment (not saying you do, just saying it's the OP's only noted thyroid test), as it can be unreliable, even in subclinical diagnosis, where T4 & T3 can be in optimal ranges.

To conclude, "if" iron/ferritin and even cortisol (when imbalanced) were to restore to adequate serum levels, that would also impact the transport process of T3 in a positive way, allowing the thyroid to function normal without any medicinal treatment?

Dr., I truly appreciate your input and completely respect all the years of dedication and study of this subject and areas pertaining to the endocrine system. I'm not quite prepared to wager my right testicle, but always looking to learn and expand my knowledge. Thanks again, and we are pleased to have yet another experienced physician in the community!!

 

[Pumpiniron13]

Looks like you're not getting enough sleep. But sleep quality (as opposed to quantity) could be a bigger factor. You say you struggle when your alarm goes off. Your usual 7-7.5hrs could be enough, but that's only if they're quality hours.

On weekends (or whenever you can sleep in), how do you feel?

Do you snore? Have been tested for sleep apnea?

What's your body fat %? (can correlate with apnea risk)

Something else to consider is your diet. Your macronutrient breakdown indicate a pretty high carb diet. Some people do better, have more energy, and are sharper mentally on a low carb, or even ketogenic diet. Or sort of a seasonal shift between low-to-high carb. Have you tried something like that?

It's not always hormones.

I’d bet he has sleep apnea. I did and I would wKe up feeling as I’ve if I’d not been to sleep. That also effects hematocrit levels( high). I use a cpap now and wake feeling rested. I also injection 3 tines a week which got me off anastrozole completely!

 

[canaleshome]

Thanks for all the responded! I'll respond to above posts shortly. I finally got my results back from my Thyroid work-up. Had to re-schedule my appt with Defy, but will have these results to review with them.

T4, free: 1.39 (0.82-1.77); TSH 1.2 (0.45-4.5); Reverse T3: 28.2 (9.2-24.1); Thyroglobulin antibody: <1.0 (0.0-0.9); Thyroid Peroxidase: 23 (0-34); Tridothyronine, Free: 3.9 (2-4.4).

Reverse T3 is only thing not is normal range; it's high. I've had trouble losing weight around my stomach over the past 7 months. I had to move out one notch on my belts. Is this something that can be related? Or am I looking too much into this?
I exercise regularly and eat good, especially when compared to a few years ago. Cut back on how much and often I drink on weekends.

 

[Systemlord]

Higher rT3 is preventing fT3 from entering your cells, same result as low fT3 causing hypothyroid symptoms. Good fT3 levels in the absence of high rT3 support fat burning and weight loss.

 

[canaleshome]

And have u checked your CBC panel? Hematocrit hemoglobin? That being elevated could definitely cause fatigue.

Yes all this is normal.

 

[canaleshome]

Dr., thank you for your input. However, I might take you up on that bet. Agreed, OP posted a rather "normal" TSH level, but in the same paragraph it was posted that he has struggled with sub-adequate ferritin (51 is still low), and also suggesting low iron serum as well. If that stands, that could/ would possibly affect the efficacy or ability for T3 to reach the cells. With that scenario, I would presume that T3 pooling could exist, possibly keeping T3 serum elevated (but not productive), thus maybe inhibiting TRH/TSH activity through the negative feedback loop (?).

I would also think that Reverse T3 would be of interest, and also comparing its ratio with FT3 (FT3:RT3), as the body could tend to shift for a higher demand of RT3 if pooling and/or other factors are evident?

For these reasons and others, I personally find it difficult to use the TSH assay as the primary marker to make any assessment (not saying you do, just saying it's the OP's only noted thyroid test), as it can be unreliable, even in subclinical diagnosis, where T4 & T3 can be in optimal ranges.

To conclude, "if" iron/ferritin and even cortisol (when imbalanced) were to restore to adequate serum levels, that would also impact the transport process of T3 in a positive way, allowing the thyroid to function normal without any medicinal treatment?

Dr., I truly appreciate your input and completely respect all the years of dedication and study of this subject and areas pertaining to the endocrine system. I'm not quite prepared to wager my right testicle, but always looking to learn and expand my knowledge. Thanks again, and we are pleased to have yet another experienced physician in the community!!

My iron was low the last go around so I've been on iron/vit c supplements twice/wk as advised by Defy. I usually give blood every 8-10 weeks, but was also told to stop doing it that much. Cut back to like every 3-4 months.

Good call on thinking Reverse T3 is of interest.

 

[1Draw]

Thanks for all the responded! I'll respond to above posts shortly. I finally got my results back from my Thyroid work-up. Had to re-schedule my appt with Defy, but will have these results to review with them.

T4, free: 1.39 (0.82-1.77); TSH 1.2 (0.45-4.5); Reverse T3: 28.2 (9.2-24.1); Thyroglobulin antibody: <1.0 (0.0-0.9); Thyroid Peroxidase: 23 (0-34); Tridothyronine, Free: 3.9 (2-4.4).

Reverse T3 is only thing not is normal range; it's high. I've had trouble losing weight around my stomach over the past 7 months. I had to move out one notch on my belts. Is this something that can be related? Or am I looking too much into this?
I exercise regularly and eat good, especially when compared to a few years ago. Cut back on how much and often I drink on weekends.

Your Reverse t3 is exactly what mine was when tested back in February. Had a severe flu/sinus infection in January and felt like I had been run over by a Mack truck after it cleared up so, got Defy to run full thyroid labs. Had my consult with Dr. Calkins and he prescribed Cytomel 3 x day - start slow and add more as symptoms dictated. Here is a good link that discusses the RT3 and causes:

https://www.restartmed.com/reverse-t3/

Stop The Thyroid Madness website is another good resource as well.

I am in my 6th week and feeling a lot better already. You want your RT3 to be less than 15 and lower is better. The truly wise Thyroid MD's do not put much value on the TSH result. Too many other variables with the thyroid that can cause problems. I thought Testosterone therapy was complicated until I started looking at thyroid hormones. It is a different world unto itself.

Good luck! You are in good hands with Defy in getting proper treatment.

 

[blackebob]

Just read the first part of this on the thyroid it's quicker than watching the video less you want to watch the video.

https://www.excelmale.com/forum/sho...-Testosterone-Interview-with-Dr-Lynese-Lawson