High TSH low T

First post, I started reading here a while back and used private md labs for the male hormone test. I havent been feeling good for a long time now and stumbled into a trt thread on a gun forum which led me here.

Here are the results, if you guys want to see any other numbers on the test (the $176 one) let me know. I have an appointment with an endo on the 4th and my gp before that on the 29th. I am switching gp's and thats the main reason for seeing both.

I was thinking of asking to have more labs done with my gp that could help when I see the endo, recommendations on what other tests to run? LH, FSH, prolactin, cortisol? I know the TSH is off, reading here it looks like I would want that around 1 not 6. The T levels are also low, which I'm hoping is a result of the thyroid and will come back to normal. If it doesnt I'm sure a 198 for a 29 year old makes me a candidate for trt. Anyways any advice is appreciated, I'll update this as things go forward with what the doctor says and treatment/results. Thanks


TSH 6.170 --------- 0.450-4.500 uIU/mL

Thyroxine (T4) --------- 8.3 4.5-12.0 ug/dL

T3 Uptake 30 --------- 24-39 %

Free Thyroxine Index 2.5 --------- 1.2-4.9 01

Testosterone, Serum 198 --------- 348-1197 ng/dL

Testosterone, Free 6.93 --------- 5.00-21.00 ng/dL

% Free Testosterone 3.50 --------- 1.50-4.20 %

Prostate Specific Ag, Serum 1.0 --------- 0.0-4.0 ng/mL

Insulin-Like Growth Factor I 195 --------- 98-282 ng/mL 02

Estradiol, Sensitive 15.2 --------- 8.0-35.0 pg/mL

It sounds like you've done your homework and know what other BW to obtain. When it comes to your thyroid that's a wicked high TSH, yet your T4 is mid-range where I'd normally expect it to be lower and indicative of hypothyroidism. In this case it may be sub-clinical. I'd think further Thyroid testing would be beneficial and I'd probably consider the following:

TSH
FT3
FT4
T3
T4
RT3
TPO Antibodies

Antibodies would be key here in your assessment of sub-clinical hypothyroidism, imho. Welcome to the forum mka! Be sure to post up your blood work on this thread when you receive it please.

Thanks Kel I'll definitely keep the thread up to date after my appointments next week, and bring the list of things to test for to my gp when I see her monday. I've read it could be subclinical also and possibly treated with just t3? instead of t4 or the ndt which a lot prefer. I'm really hoping getting the thyroid figured out gets my T levels back up to normal, but do you think that it will work that way? In the thread I've been reading on the gun forum lots of guys have thyroid issues and also take test, hoping it can be solved with pills instead of several shots a week but whatever it takes to feel better.

Step one is always to treat the actual problem first, not band aid it. In this case the band aid is testosterone. And yes, returning to healthy thyroid function would enhance T levels. How much is anyone's guess as we are all different, but assuming that's the only issue I'd think the difference could be dramatic.

Do whatever you have to do to restore your T levels. The worlds a better place when T levels are optimized.

Hopeful that the thyroid solves it all, a life of shots is not something I want if I can avoid it. But like you said whatever it takes I'll do, if the thyroid gets fixed and t doesn't come up like it should I'd rather start with something like clomid and give it a run. If I have all the suggested tests done would those indicate whether something like clomid would be a starting point or do you just need to try that and just see how it works?

Well, the BW in the thread will basically cover all bases and help to lead you in the proper direction with what's wrong. Many things can suppress T levels beyond hypothyroidism as you well know. It's always best to have the full picture to evaluate. Clomid would be a great choice imho for someone your age, if it gets to that point.

Outcomes of clomiphene citrate treatment in young hypogonadal men. - PubMed - NCBI

Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

Went to the endo today. He ran the tests below, the others that we had talked about he basically blew off saying they werent needed which kinda bothered me. And also downplayed the test number saying if my libido wasnt gone then he almost didnt care. And when I asked about treatment and brought up the NDT he completely tossed that possibility aside, said no one recommends that pretty much and it wasnt a good solution. T4 treatment and call it a day, but since my TSH number is closer to normal I dont know what he'll say at all now.

Thyroperoxidase Antibody ---------0.80 IU/mL ---------0.00 - 9.00 IU/mL

TSH ---------2.05 uIU/mL ---------0.40 - 4.00 uIU/mL

Free T4 ---------0.8 ng/dL ---------0.5 - 1.6 ng/dL

Prolactin ---------12.6 ng/mL ---------4.4 - 16.4 ng/mL

FSH ---------3.9 mIU/mL ---------0.0 - 14.0 mIU/mL

LH ---------2.2 mIU/ml ---------0.8 - 7.6 mIU/ml





And this was a TSH number from 1/8/14 thats on my records, and some other from older labs that I dont remember them telling me they ran.

TSH ---------1.29 uIU/mL ---------0.40 - 4.00 uIU/mL


And this from 11/28/12

TSH ---------0.98 uIU/mL ---------0.40 - 4.00 uIU/mL

Free T4 ---------0.8 ng/dL ---------0.5 - 1.6 ng/dL


3/23/12 ---------TSH ---------4.32 uIU/mL ---------0.40 - 4.00 uIU/mL

So it seems like my thyroid is just all over the place depending on when its ran. It will probably be a week before I get my new T results which I'll post up then. I havent done any research on the lh/fsh/prolactin numbers so I'll be doing some reading on those tonight, I dont know what they mean right now.

Yes, your TSH is all over the place. Yes, testing a different times throughout the day and also fasted or non-fasted will impact results, think circadian rythm. This can all make a difference. Main thing is not TSH but the rest of your numbers. TSH presents no symptoms, other numbers do...

LH & FSH signal your testies to produce testosterone and sperm, in that order. Hypothyroidism and / or prolactin issues can impact (suppress) both.

Do any of the new results say anything to you? Im not sure if the lh/fsh numbers are really low or just lower end of the range, same for the antibody test.

The doc also checked out my right testicle, I told him I have a sort of knot that is towards the top but its been there since my early teens or so. He said since it usually gives no pain it shouldnt be an issue. I thought it might be a swollen epididymis or thats the conclusion I made when I initially looked it up years ago, but who knows he said I could have it check out and maybe I should.

Got my T results back too and an email from the doc.

Testosterone -----278 ng/dL ---------250 - 1100 ng/dL

Mka, everything looks normal except for the low T. At this time, the options would be to observe with no treatment, try testosterone, or try clomiphene (may help your body resume normal testo production, but only while taking it). If you'd like to discuss further, please come in, thanks.

So I'm gonna take him up on the clomid, see if I can try it a couple months and retest and go from there.

Quote:

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Originally Posted by mka

The doc also checked out my right testicle, I told him I have a sort of knot that is towards the top but its been there since my early teens or so. He said since it usually gives no pain it shouldnt be an issue. I thought it might be a swollen epididymis or thats the conclusion I made when I initially looked it up years ago, but who knows he said I could have it check out and maybe I should.

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Consider an ultrasound for your testicals. The knot could be indicative of a varicocele. If it's palpable I'd get it checked as it can suppress T levels.

Quote:

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Originally Posted by mka

Got my T results back too and an email from the doc.

Testosterone -----278 ng/dL ---------250 - 1100 ng/dL

Mka, everything looks normal except for the low T. At this time, the options would be to observe with no treatment, try testosterone, or try clomiphene (may help your body resume normal testo production, but only while taking it). If you'd like to discuss further, please come in, thanks.

So I'm gonna take him up on the clomid, see if I can try it a couple months and retest and go from there.

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Clomid is a good first choice. Take it at bed time. Let us know how you do please.

I replied and said I'd like to try the clomid first, I asked if he will prescribe it or if I need to have a follow up appointment first and then prescribe it. If I do have to follow up in person I'll have him make the referral for an ultrasound and see what he what it shows. I'll keep updating as I go along, again thanks kel for help and advice.

Varicocelectomy is associated with increases in serum testosterone independent of clinical grade. - PubMed - NCBI