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Thread: HRT Bloodwork, Thyroid, PSA out of whack

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    HRT Bloodwork, Thyroid, PSA out of whack

    Had my most recent blood work recently, got the results back. Everything looks good EXCEPT TSH and PSA. Those are both almost certainly unrelated, and the Total PSA may be the result of an infection. Any thoughts on the TSH? I know it could be anything from 'pheh, just retest in 30 days' to Thyroid cancer... The number isn't that far off so I'm not TOO worried about. T3 and T4 are consistent with previous labs.

    My routine, for those that are interested:
    Clomid 25 mg 3x per week
    .25 mg Arimidex once every 14 days.
    10mg liquid Boron every day.

    The week before bloods, I switched to 4x25 on the Clomid because I was feeling tired. TSH might be the culprit there? At any rate, likely to adjust this dosage.

    Yes, the adex is once every two weeks. It seems to help keep the puffiness down.

    The Boron is the wild card here. I have been running it for about 30 days. I had read a study that said that dose could reduce SHBG by 20%, so I ran that to see what I got. Though the doc does not pull SHBG (or Sensitive E2), I feel like the Boron likely was a success. My SHBG typically runs a little over range, and knocking that down should increase Free T. Free T is up, so maybe there is something to it.

    My next course of action will be:
    Meet with the doc in a couple of days to address the TSH and PSA in particular.
    Discuss with the doc the possibility of the clomid causing issues with the thyroid (a real possibility, if Dr Google can be believed)
    Adjust the protocol slightly to radically. I may get off the clomid entirely and switch to T.

    Anyhow, I will discuss all that with the doc and see where we land.

    Any thoughts on the TSH or anything else is as always, much appreciated.

    HRT Bloodwork, Thyroid, PSA out of whack-cylon357-01.jpg HRT Bloodwork, Thyroid, PSA out of whack-cylon357-03.jpg HRT Bloodwork, Thyroid, PSA out of whack-cylon357-04.jpg
    Last edited by cylon357; 07-20-2020 at 07:17 PM. Reason: Because F is not T, and it isn't a Fhyroid
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    Did you mean TSH instead of FSH?
    I cant open your links.


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    Quote Originally Posted by charger69 View Post
    Did you mean TSH instead of FSH?
    I can’t open your links.


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    Yes, dang it, TSH. I'm a donkey atm.

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    Quote Originally Posted by charger69 View Post
    Did you mean TSH instead of FSH?
    I can’t open your links.


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    TSH was 5.28 Range of .40 to 4.50
    PSA was 6.5 but percent free was 31% so I'm figuring that is another infection.

    Other numbers by and large look good.

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    Your TSH is high but your T4 and T3 are in range.
    This shows that although your thyroid is functioning it is struggling to produce normal amounts of hormones.
    You could possibly have Hashimoto's which is where your immune system is attacking your thyroid.
    They should test for thyroid antibodies to rule out Hashimoto's.
    Do you get enough iodine in your diet?
    Iodine is vital for thyroid health.

    Your PSA is concerning because it is a measure of your prostrate's health. I know next to nothing about that.
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    Quote Originally Posted by The Deadlifting Dog View Post
    Your TSH is high but your T4 and T3 are in range.
    This shows that although your thyroid is functioning it is struggling to produce normal amounts of hormones.
    You could possibly have Hashimoto's which is where your immune system is attacking your thyroid.
    They should test for thyroid antibodies to rule out Hashimoto's.
    Do you get enough iodine in your diet?
    Iodine is vital for thyroid health.

    Your PSA is concerning because it is a measure of your prostrate's health. I know next to nothing about that.
    My PSA jumps around like Shakira on crack, so I'm not overly concerned about it. Hopefully, that is just an infection and antibiotics will fix that up. I had that happen before, so fingers crossed.

    Not sure on the iodine, but I have been Dr Googling tsh and saw hashimoto, iodine etc. I'm not familiar with those yet,but not overly concerned about it either right now. I'll talk to the doc in a couple of days and see what next steps are.

    Basically, I'm trying not to worry about anything until I have something to worry about.

    But dammit if the rest of those numbers don't look good!

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    Quote Originally Posted by cylon357 View Post
    TSH was 5.28 Range of .40 to 4.50
    PSA was 6.5 but percent free was 31% so I'm figuring that is another infection.

    Other numbers by and large look good.
    Its funny.. in a strange way. I had an infection and then had my thyroid removed.
    Yes, it appears that you do have an infection. The TSH measures how strong the signal is from the pituitary to your thyroid to produce. Mine was over 12 with the T4 I was prescribed. The scale for mine was .5 to 3.3.
    The fact that your TSH was high does not mean you have cancer. I had cancer and everything was working fine with my thyroid.


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    Quote Originally Posted by charger69 View Post
    It’s funny.. in a strange way. I had an infection and then had my thyroid removed.
    Yes, it appears that you do have an infection. The TSH measures how “strong” the signal is from the pituitary to your thyroid to produce. Mine was over 12 with the T4 I was prescribed. The scale for mine was .5 to 3.3.
    The fact that your TSH was high does not mean you have cancer. I had cancer and everything was working fine with my thyroid.

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    Oh yeah, I'm betting on it not being cancer (either of the prostate or thyroid or both)... I try to be aware of the possibilities and more importantly the probabilities. I'm going to angle for running a round of antibiotics and retesting in a month.

    These numbers are for my annual physical, so the doc will want to do a DRE, especially since my PSA is spiking. Well, WANT might be a bit strong... I figure he enjoys DRE's no more than I do (though I really can't speak for him and his quirks, so what do I know?). At any rate, I'll meet the doc on Thursday and update here when we have a plan of attack.

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    I would definitely plan on seeing and endo about your TSH.

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    Don't discount the possiblilty that the extra 25 mgs of clomid caused this ramping up of tsh.

    Oh, and Shakira on crack wins hands down over the mental image of your prostate....
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    Quote Originally Posted by kelkel View Post
    Don't discount the possiblilty that the extra 25 mgs of clomid caused this ramping up of tsh.
    just read about this...
    thanks for the info

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    Quote Originally Posted by kelkel View Post
    Don't discount the possiblilty that the extra 25 mgs of clomid caused this ramping up of tsh.

    Oh, and Shakira on crack wins hands down over the mental image of your prostate....
    Oh snap, I lol'ed!

    I did see where clomid can impact thyroid function, might be reason enough to move away from it. I meet with the doc tomorrow so we'll see what he says.

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    Quote Originally Posted by cylon357 View Post
    Oh snap, I lol'ed!

    I did see where clomid can impact thyroid function, might be reason enough to move away from it. I meet with the doc tomorrow so we'll see what he says.
    TSH measurement alone does not determine your thyroid function. The production. Of T3 and T4 does determine thyroid function.
    TSH measures the signal from the pituitary for the thyroid to produce. Since it is a feedback loop it USUALLY goes up with low production and down with high production .
    No Dr in their right mind would start adjusting T4 or T3 levels without the direct measurement of thyroid function (T3 and T4).


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    Quote Originally Posted by charger69 View Post
    TSH measurement alone does not determine your thyroid function. The production. Of T3 and T4 does determine thyroid function.
    TSH measures the signal from the pituitary for the thyroid to produce. Since it is a feedback loop it USUALLY goes up with low production and down with high production .
    No Dr in their right mind would start adjusting T4 or T3 levels without the direct measurement of thyroid function (T3 and T4).


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    Free T3 and free T4 were on the results. Both were in range and consistent with results from a year ago.

    Free T4 result 1.2 Range: 0.8-1.8 ng/dL
    Free T3 result 2.7 Range: 2.3-4.2 pg/ml

    I'm guessing you still can't see the links?

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    Alright, so I met with the doc the other day. Here are the details:

    Discussion with Doc

    He doesn't think it is likely that the clomid is causing anything out of whack with the TSH, but I'm not convinced. That said, he WAS concerned about the TSH levels and prescribed Levothyroxine 100mcg daily. Doc said thyroid felt fine, no swelling or anything of concern other than TSH. He did mention that he likes to see TSH at 2.0 or less.

    We are going to try another round of antibiotics for the PSA. We talked about Fina for BPH again. I told him I would come off HRT before going on Fina again (I encountered ALL the negative sides though they went away after discontinuing the drug). He asked me to consider Dutasteride in place of Fina. Since my insurance covers it, I said I would think about it. After some investigation, I have decided not to use this.

    When I mentioned that I added boron, before I could finish he said 'to lower shbg'. So, evidently he knows about this and approves, in the for what it's worth category.

    The DRE indicated the prostate was 'swollen but smooth', so not much concern about prostate cancer. We talked about biopsies and TURP as future possibilities, well down the road. On a related note, my new nickname is 'Swollen but Smooth'.

    We are going to pull bloods again in 6 weeks.

    That's basically how the conversation went.

    Action plan

    I'm going to start the antibiotics and the levothyroxine. I may try to restart the thyroid at some point, if such a strategy exists.

    I'm going to cut my clomid dose back from 3 or 4 x 25mg to 2 x 25 mg per week. My goal there is to bring the DHT down some while still keeping good to very good Total and Free T numbers. And really, Free T is the one I'm chasing, so if Total comes down 20 to 30 percent, I'm still good. I'll keep the boron in the rotation to help with this. With that low a dose of clomid, I should be able to get rid of the adex altogether.

    My overall strategy right now is 'less is more', that is, what is the minimum drug regimen I can do to get the maximum benefit.


    Any thoughts, particularly on the thyroid?

    Oh and just to be clear, I thank you all for your support and feedback. I've said it before: this is the best damn support network out there.
    Last edited by cylon357; 07-30-2020 at 11:13 AM.

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    I definitely agree that a course of antibiotics is worth a try to address the high PSA. I think way too many docs want to jump straight to a biopsy rather than consider that an infection may be involved. See the graph below for my PSA history. It was <1 for about 12 years, the last 8 of which on TRT. Then suddenly it shot up over 8. I started a 40-day treatment with ciprofloxacin and that immediately brought it back down to baseline. My doc gave me a standing order for PSA labs as frequently as every 4 weeks to monitor it. Lately it's been drifting up slightly, so I'm going to stick to the 4 week PSA screenings to monitor it closely. Got another one in about 2 weeks. If it continues to drift up, I'll request another round of antibiotics.
    HRT Bloodwork, Thyroid, PSA out of whack-psa-graph.jpg
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    Quote Originally Posted by Youthful55guy View Post
    I definitely agree that a course of antibiotics is worth a try to address the high PSA. I think way too many docs want to jump straight to a biopsy rather than consider that an infection may be involved. See the graph below for my PSA history. It was <1 for about 12 years, the last 8 of which on TRT. Then suddenly it shot up over 8. I started a 40-day treatment with ciprofloxacin and that immediately brought it back down to baseline. My doc gave me a standing order for PSA labs as frequently as every 4 weeks to monitor it. Lately it's been drifting up slightly, so I'm going to stick to the 4 week PSA screenings to monitor it closely. Got another one in about 2 weeks. If it continues to drift up, I'll request another round of antibiotics.
    Click image for larger version. 

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    I think I remember us talking PSA before, when mine spiked due to an infection. The doc gave me 10 days of doxycycline at that time and it cleared up. He gave me 30 days this time but I may only run it for 15 (I hate the idea of being on antibiotics that long). It's funny but I swear I can tell a difference after only a day or two.

    Retesting in about 6 weeks to see where everything lands.
    Last edited by cylon357; 07-27-2020 at 07:30 AM.

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    Boron sounds like an impressive supplement. Has anyone noticed a big difference with free test levels during a cycle while taking boron?

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    Talk to your doc about Nolvadex to help with your prostate.
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    Quote Originally Posted by cylon357 View Post
    It's funny but I swear I can tell a difference after only a day or two.
    Oh, I definitely could too. I had a REALLY BAD infection. I was getting night sweats too. The night sweats cleared up the first night after a full day of antibiotics. Pretty amazing! I am starting to have minor night sweats again the past week, so I think the small blip up at the end of the graph might indicate a recurrence of the infection. Have another 10 days before i can get retested, but I'm pretty sure I'll be asking for some more ciprofloxacin.

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    Quote Originally Posted by kelkel View Post
    Talk to your doc about Nolvadex to help with your prostate.
    That is one of the many damn things I forget to bring up. I'll make a note for the follow-up though.

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    HRT Bloodwork, Thyroid, PSA out of whack

    Im shocked that your doc started you on 100mcg of levo! 5 is elevated but not extreme. Most docs start at 25-50mcg just to help relieve the stress on your tsh. You may end up hyperthyroid with 100mcg. I definitely think you should go to an endo to get checked for hashimotos and see what the possible underlying cause is.
    Last edited by KittyO1; 07-31-2020 at 07:26 AM.
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    Quote Originally Posted by KittyO1 View Post
    Im shocked that your doc started you on 100mcg of levo! 5 is elevated but not extreme. Most docs start at 25-50mcg just to help relieve the stress on your tsh. You may end up hyperthyroid with 100mcg. I definitely think you should go to an endo to get checked for hashimotos and see what the possible underlying cause is.
    I had my thyroid removed and I started out at 125. Obviously, he is still adjusting, but he started me out low. I am up 15 lbs on the same exact diet that I was on with no weight gain.


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    Quote Originally Posted by KittyO1 View Post
    I’m shocked that your doc started you on 100mcg of levo! 5 is elevated but not extreme. Most docs start at 25-50mcg just to help relieve the stress on your tsh. You may end up hyperthyroid with 100mcg. I definitely think you should go to an endo to get checked for hashimotos and see what the possible underlying cause is.
    Yeah, I thought (based on my 20 minutes of Google experience) that 100 seemed a little high, too. My doc tends to go nuclear on the front end.. that is, he likes to hit things hard then back down. I was having a bit of insomnia at 100, so I've been cutting the tabs in half so I've really been taking 50.

    We retest in about 5 weeks so we'll see where that lands. He did say he likes to see TSH around 2.0, which is well under the upper end of the range for the test I took.

    I'm also looking into a thyroid reset if such a thing exists.

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    Quote Originally Posted by charger69 View Post
    I had my thyroid removed and I started out at 125. Obviously, he is still adjusting, but he started me out low. I am up 15 lbs on the same exact diet that I was on with no weight gain.


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    Thats so frustrating!!

    Quote Originally Posted by cylon357 View Post
    Yeah, I thought (based on my 20 minutes of Google experience) that 100 seemed a little high, too. My doc tends to go nuclear on the front end.. that is, he likes to hit things hard then back down. I was having a bit of insomnia at 100, so I've been cutting the tabs in half so I've really been taking 50.

    We retest in about 5 weeks so we'll see where that lands. He did say he likes to see TSH around 2.0, which is well under the upper end of the range for the test I took.

    I'm also looking into a thyroid reset if such a thing exists.
    Wow! Id say so! I actually wish I could find a doctor more like that- at least willing to try! Sounds like @charger69 needs one too!
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    Question

    Cyl, thanks again for linking me. Sorry if you hinted at this in your response - One thing Im finding confusing in my research: Is Clomid Monotherapy ongoing like TRT or can it be used as a restart? Overall im not finding any stories of successful restarts by people trying alternate HRT via HCG or SERMs - then maintaining healthy T levels without the aid of drugs. Ive been on 10mg of Boron for a few days now per your reccomendation. Thanks as always for your valuable insight.

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    Quote Originally Posted by ShredBundy View Post
    Cyl, thanks again for linking me. Sorry if you hinted at this in your response - One thing Im finding confusing in my research: Is Clomid Monotherapy ongoing like TRT or can it be used as a restart? Overall im not finding any stories of successful restarts by people trying alternate HRT via HCG or SERMs - then maintaining healthy T levels without the aid of drugs. Ive been on 10mg of Boron for a few days now per your reccomendation. Thanks as always for your valuable insight.
    For me, it is intended as long term HRT. You MIGHT be able to restart using Clomid alone - some people do PCT with Clomid only and get by. Though for restart for the long term, I suspect one of the Power PCT protocols might be in order.

    If you wanted to be off all pharmaceuticals, be aware that boron should still bring benefit. It (presumably) works by lowering SHBG in assisted or non assisted people.

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    Quote Originally Posted by cylon357 View Post
    For me, it is intended as long term HRT. You MIGHT be able to restart using Clomid alone - some people do PCT with Clomid only and get by. Though for restart for the long term, I suspect one of the Power PCT protocols might be in order.

    If you wanted to be off all pharmaceuticals, be aware that boron should still bring benefit. It (presumably) works by lowering SHBG in assisted or non assisted people.
    Understood. I have upped the dose of Boron to 9mg a day (capsules are 3mg ea), and can honesty say since discontinuing arimidex and implementing the Boron, I’m feeling noticeably better! Using this triple complex from Swanson but might try the liquid brand you recommended next.

    HRT Bloodwork, Thyroid, PSA out of whack-ba8a77a6-1e1c-442d-afd2-15922008d2fd.jpeg
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    Quote Originally Posted by ShredBundy View Post
    Understood. I have upped the dose of Boron to 9mg a day (capsules are 3mg ea), and can honesty say since discontinuing arimidex and implementing the Boron, I’m feeling noticeably better! Using this triple complex from Swanson but might try the liquid brand you recommended next.

    Click image for larger version. 

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    Since you did both, it is hard to say which had the greater effect, though I think it is likely each had a positive impact. Glad to hear things are improving!
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    Quote Originally Posted by KittyO1 View Post
    That’s so frustrating!!


    Wow! I’d say so! I actually wish I could find a doctor more like that- at least willing to try! Sounds like @charger69 needs one too!
    Yeah, my doc is pretty good so far. The only rub I have is that he pulls estrogen not e2 sensitive. Thats another thing I keep forgetting to ask about.

    I did have my follow up blood work drawn today, so results should be available in about a week. I have a call with the doc the week after that so we will see where we landed.

    I do think the antibiotics helped with the prostate, though, so that's good. Blood work will tell the tale for sure though.

    I also did cut my Boron dose back to 5mg per day from 10. Yes, that might cost me some free t, but it should also bring the dht down ever so slightly. With it at the absolute top of range (63 with top of range being 65), I'm probably getting some prostate issues. If I can get it to between 50 and 55, I'll be happy, I think.

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    And even at 50mcg of levothyroxine daily,I feel like my thyroid has improved. I'm not waking up with blood shot eyes or seriously napping during the day. We'll see about that, too, when bloods come back.

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    Is there anybody out there with on cycle labs taking boron and able to show changes to free T? It seems theoretically possible to make lower dosage cycles punch above their weight and give better results.

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    Quote Originally Posted by beanpo1e View Post
    Is there anybody out there with on cycle labs taking boron and able to show changes to free T? It seems theoretically possible to make lower dosage cycles punch above their weight and give better results.
    If you are cycling, there are other compounds to reduce SHBG that bring more bang for the buck, so my guess is no one is going to have an answer for you on that.

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    Ok, so I got my most recent blood work back. Things are looking much improved, so I'm pleased.

    Basically, after my last bloodwork like 6 weeks ago, I dropped the Boron to 5mg per day, added fermented ginseng at 8 drops per day, have been taking 50mcg Levothryroxine per day, and had a two week run of 5-10mg Nolvadex daily, ending that about a week before follow up blood work. I wish I had not run the nolva before the bloods, because I'm not sure what impact it had on my numbers. Oh, and of course, the 30 day run of doxycycline for any possible prostate infection.

    Anyhow, TSH and PSA are both dramatically improved so that's great. But that DHT tho..... Not sure what is going on there, though maybe it is possible the boron is hammering my SHBG? I feel GOOD, by and large, maybe a little pugnacious at times, but the mind is clear and sharp.

    I have my follow up call with the doc Tuesday, I think, so we will review and address from there.

    Oh and for @Charger69, I'll summarize my numbers:
    PSA went from 6.5 to 3.4 (<4.0)
    TSH went from 5.28 to 1.75 (.40 to 4.50 range)
    DHT went from 63 to 128 (12 to 65 range)
    Free T3 went from 2.7 to 3.2 (2.3 to 4.2 range)

    Everything else was functionally the same.

    HRT Bloodwork, Thyroid, PSA out of whack-cylon357sep2020-01.jpg HRT Bloodwork, Thyroid, PSA out of whack-cylon357sep2020-02.jpg

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    Maybe I will ask to pull SHBG on next bloodwork. One more thing to try not to forget to ask about...

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    This also might and I mean MIGHT be an instance where I would consider super low dose finasteride. Like .25 mg or less once, maybe again 2 weeks later if I didn't get any sides.

    But my first course of action is going to be eliminating the boron to see if shbg picks up the dht.

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    Quote Originally Posted by cylon357 View Post
    TSH was 5.28 Range of .40 to 4.50
    PSA was 6.5 but percent free was 31% so I'm figuring that is another infection.

    Other numbers by and large look good.
    Hey Cylon, you dont take any Kratom do you? I know from personal experience that Kratom taken all day every day for a while will cause hypothyroidism. Just throwing this out there. When I cut my Kratom usage to once a day and threw some Ashwaghanda in my numbers went back to normal.

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    Quote Originally Posted by Madcox View Post
    Hey Cylon, you don’t take any Kratom do you? I know from personal experience that Kratom taken all day every day for a while will cause hypothyroidism. Just throwing this out there. When I cut my Kratom usage to once a day and threw some Ashwaghanda in my numbers went back to normal.
    I do not use kratom but do use like 300mg of ashwaganda nightly.

    I was using mk677, ipamorelin and semorelin, so its possible those had an impact on my tsh. I stopped about a month before the first bloods. None of those peps are supposed to impact levels like that but maybe they did. TSH came down nicely though, so we may reduce levo dose and reassess in a month.

    Dht is the one making me go hmm right now...
    Madcox likes this.

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    Is there anything that is legit for bringing down DHT that is NOT finasteride or dutasteride? I REALLY don't want to revisit those....

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