Endo won't prescribe test until my thyroid is up

[Gettingstronger!]

Hi guys,

Hoping someone can help me.

been seeing my endocrinologist over the last 9 months regarding low thyroid, testosterone & others. My symptoms feel quite debilitating.

My latest results show thyroid is low and testosterone very low (please see below for blood test results & ref ranges).

My endo won't prescribe me testosterone as he believes my low thyroid levels make it useless, he mentioned how they use the same receptors and when I questioned this he completely baffled me with medical jargon. Is he correct??

Thanks all.


ALBUMIN
43g/L
Ref Range35 to 50

FREE T4
12.7pmol/L
10.0 to 23.0

FREE T3
3.0pmol/L
3.5 to 6.5

TSH
1.53mU/L
0.40 to 5.00

PROLACTIN
98mIU/L
86 to 324

LH
4.1IU/L
1 to 9

FSH
1.8IU/L
1 to 10

TESTOSTERONE
3.3nmol/L
9.9 to 27.8

SEX H.B.GLOBULIN
58nmol/L
15 to 70

CALCULATED FREE TESTOSTERONE
42pmol/L

Coded Comment For Above Test: CFT > 250pmol/L Normal CFT = 180 to 250pmol/L Borderline CFT < 180pmol/L Low

[Vettester]

I'll comment, but I have some odds and ends to tend to today. I can respond and make other comments later ...

Your total T serum = 93ng/dl on the scale that we are more familiarized with on this forum. Your free testosterone calculates at 1.26% (1.18ng/dl). SHBG is high, even when/if serum levels increase to a normal range, you will still have a free test deficiency until you get this under control. 2% to 3% would be the ideal range to aim for as your program evolves.

There is a tight correlation with hypothyroidism and hypogonadism. Yes, receptor sites, specifically nuclear receptors function collaboratively with these hormones, but other variables are involved with ensuring the transport and production of these hormones, let alone the bio-availability factor once levels are sustained.

Your test is tanked, no disputes. Your LH assay presented is 'mildly' low, but not tanked. However, your FSH is definitely low. 2 Fold (1 part pituitary, 1 part testicular) ... I think the pituitary needs further investigation, possibly an MRI, and some of that needs to be considered as well due to level of TSH being presented in comparison to the amount of T4 and T3 posted on your labs. The feedback loop IMO should have a much higher rate of TSH compared to the amount of actual thyroid hormones. It's either that, or possible adrenal fatigue/cortisol issues, which over time can suppress TSH function. Other labs are needed ... RT3, TPO antibodies, Iron/ferritin, saliva cortisol, B12, DHEA ... To know more about your actual thyroid status. The other part of this .... It wouldn't hurt to take a closer look at the testicular side of it. If we base it just strictly on LH, one would expect some higher serum levels. a serum score < 100ng/dl can usually indicate some primary type issues. If there's damage to 1 or both testicles, that makes a little more sense.

I personally think your physician needs MORE information before he can even treat your thyroid (as noted above), but I don't quite see his rationale to just go mono-thyroid and presume that the testosterone will normalize. However, he has the medical degree, I don't, so possibly he's on to something I don't know. Regardless, issues like SHBG won't just totally fade away. That's a variable that would need addressed in order to get optimal bio available testosterone.

[Gettingstronger!]

Hi Vettester,

Thanks for your response!

I've had an MRI already which came back fruitless. I was referred on from my primary endo to a more specialized endo & geneticist, who told me I had a genetic form of combined hypopituitarism. They had already agreed in this meeting that testosterone replacement was required, as well as growth hormone & thyroid replacement. Upon being referred back to my endocrinologist (who by the way comes across as an asshole) he tells me that he'd feel more comfortable doing one at a time, he never gives me straight answers, I don't think he's a "people" person.

Funnily enough, I was hoping someone here would shed some light on his rationale, as I'm bloody clueless.

[Rusty11]

I'll comment, but I have some odds and ends to tend to today. I can respond and make other comments later ...

Your total T serum = 93ng/dl on the scale that we are more familiarized with on this forum. Your free testosterone calculates at 1.26% (1.18ng/dl). SHBG is high, even when/if serum levels increase to a normal range, you will still have a free test deficiency until you get this under control. 2% to 3% would be the ideal range to aim for as your program evolves.

There is a tight correlation with hypothyroidism and hypogonadism. Yes, receptor sites, specifically nuclear receptors function collaboratively with these hormones, but other variables are involved with ensuring the transport and production of these hormones, let alone the bio-availability factor once levels are sustained.

Your test is tanked, no disputes. Your LH assay presented is 'mildly' low, but not tanked. However, your FSH is definitely low. 2 Fold (1 part pituitary, 1 part testicular) ... I think the pituitary needs further investigation, possibly an MRI, and some of that needs to be considered as well due to level of TSH being presented in comparison to the amount of T4 and T3 posted on your labs. The feedback loop IMO should have a much higher rate of TSH compared to the amount of actual thyroid hormones. It's either that, or possible adrenal fatigue/cortisol issues, which over time can suppress TSH function. Other labs are needed ... RT3, TPO antibodies, Iron/ferritin, saliva cortisol, B12, DHEA ... To know more about your actual thyroid status. The other part of this .... It wouldn't hurt to take a closer look at the testicular side of it. If we base it just strictly on LH, one would expect some higher serum levels. a serum score < 100ng/dl can usually indicate some primary type issues. If there's damage to 1 or both testicles, that makes a little more sense.

I personally think your physician needs MORE information before he can even treat your thyroid (as noted above), but I don't quite see his rationale to just go mono-thyroid and presume that the testosterone will normalize. However, he has the medical degree, I don't, so possibly he's on to something I don't know. Regardless, issues like SHBG won't just totally fade away. That's a variable that would need addressed in order to get optimal bio available testosterone.

Good god, Vette....your knowledge and expertise is such a huge asset to this forum. Great post.

[Vettester]

Good god, Vette....your knowledge and expertise is such a huge asset to this forum. Great post.

Thanks, Rusty!! I did stay at a Holiday Inn Express !