New to TRT and Have Decisions to Make (w/Bloodwork).

[TakeTwo]

Tried posting over the weekend but it never showed up. Attempt #2:

Briefly: 35, average height/weight, decided to get tested and see if TRT was an option. Bloodwork showed the following:

Total T: 244
Free T: 6.1
LH: 1.4
FSH: 1.5

No diabetes and I've had my thyroid checked in the past. From what I understand--and it's hardly a complete education--low T combined with low LH/FSH may point to a pituitary issue, where the testes are working but not getting enough of a signal to produce T.

Went to a TRT-educated doctor and he recommended 150mg/weekly of test subQ, with no AI or HCG. I asked if Clomid might be warranted to see if I could jump-start my production naturally, but he doesn't prescribe it and the best he could promise was that he'd look into it. Honestly, I'd rather try Clomid for a few months before committing to test for life, unless I'm missing something.

Re: the HCG/AI, he feels like that would only be warranted if follow-up BW shows increased estrogen or any signs of shrinkage. I'm curious how injecting subQ compares to intra-muscular pinning, and if I should push harder for Clomid. Also wondering if I should try to get prolactin or SHBG checked. Finally, how common is the blood thickening issue on T? I'm a worrying type and don't want to jump on something that could give me anxiety over a stroke or heart attack.

If anyone can advise me, I'd appreciate it. Thanks in advance.

[OingoBoingo]

For best responses, you might want to post your ranges along with your results. And since you're going through the trouble, might as well post all your results and ranges. You never know what these guys might find; such as thyroid or Vitamin D issues.

If you want hCG and an AI and this one won't give it to you, find another doctor. I would be more comfortable starting around 100mg per week, and titrate up if needed.

Subcutaneous Testosterone injections compare well with Intra Muscular. I inject small amounts SQ daily with a 30g needle. Easy and painless.

hCG and AIs aren't the same. In a nutshell, hCG mimics the Luteinizing Hormone (keeping the boys alive and plump), and AIs reduce E2.

Check the stickies for a list of items to include in your lab work.

If blood thickness worries you, get it checked. Some on the forum give blood every two months for peace of mind.

When I decided to "jump on" I felt very bad. And I didn't really know just how bad it was until I started to feel better. Not jumping on really wasn't an option because I couldn't go on feeling that way. Where I live, the Red Cross declares a blood emergency often. Happy to help the natives out, and at the same time myself. I keep a daily log with my pulse and blood pressure in an effort to keep an eye on things.

You can address your fears, but get a doctor who will work with you.

There's lots of great information on the forum. Read your ass off. Become educated, and you'll have better discussions with the doctors.

Good luck!

[Beethoven]

I agree with oingoboingo, I would start at 100 mg a week and work from there. Post your ranges and all your BW. There are very knowledgeable people on here that are always willing to help out. I've had blood thickening issues but I get blood drawn every couple of months and have a low dose aspirin regimen that keeps me good.

[The_Crawfish]

He shouldn't be prescribing an AI right out of the box as you won't know what your E2 levels will be...it would be like shooting in the dark, and crashing your E2 can be just as bad as too much. I also would suggest a starting dose of 100mg/wk, split into 2 doses.
I switched to subq from IM a few weeks ago and wouldn't want to go back.

[TakeTwo]

This is everything ordered. Estradiol, Vitamin D, SHBG, and prolactin were not measured.

CBC With Differential/Platelet
WBC 6.0 x10E3/uL (Reference Interval 3.4 - 10.8)
RBC 5.60 x10E6/uL 4.14 - 5.80
Hemoglobin 15.5 g/dL 12.6 - 17.7
Hematocrit 44.9 % 37.5 - 51.0
MCV 80 fL 79 - 97
MCH 27.7 pg 26.6 - 33.0
MCHC 34.5 g/dL 31.5 - 35.7
RDW 14.3 % 12.3 - 15.4
Platelets 207 x10E3/uL 155 - 379
Neutrophils 61 % 40 - 74
Lymphs 30 % 14 - 46
Monocytes 6 % 4 - 12
Eos 2 % 0 - 5
Basos 1 % 0 - 3
Neutrophils (Absolute) 3.7 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 1.8 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.4 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 % 0 - 2
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1

Comp. Metabolic Panel (14)
Glucose, Serum 95 mg/dL 65 - 99
BUN 15 mg/dL 6 - 20
Creatinine, Serum 0.98 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 99 mL/min/1.73 >59
eGFR If Africn Am 115 mL/min/1.73 >59
BUN/Creatinine Ratio 15 8 - 19
Sodium, Serum 143 mmol/L 134 - 144
Potassium, Serum 5.9 High mmol/L 3.5 - 5.2
Chloride, Serum 104 mmol/L 97 - 108
Carbon Dioxide, Total 26 mmol/L 19 - 28
Calcium, Serum 10.1 mg/dL 8.7 - 10.2
Protein, Total, Serum 7.0 g/dL 6.0 - 8.5
Albumin, Serum 4.8 g/dL 3.5 - 5.5
Globulin, Total 2.2 g/dL 1.5 - 4.5
A/G Ratio 2.2 1.1 - 2.5
Bilirubin, Total 0.3 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 76 IU/L 39 - 117
AST (SGOT) 16 IU/L 0 - 40
ALT (SGPT) 22 IU/L 0 - 44

Lipid Panel
Cholesterol, Total 215 High mg/dL 100 - 199
Triglycerides 68 mg/dL 0 - 149
HDL Cholesterol 60 mg/dL >39
VLDL Cholesterol Cal 14 mg/dL 5 - 40
LDL Cholesterol Calc 141 High mg/dL 0 - 99

Testosterone,Free and Total
Testosterone, Serum 244 Low ng/dL 348 - 1197
Comment:
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 6.1 Low pg/mL 8.7 - 25.1
FSH and LH
LH 1.4 Low mIU/mL 1.7 - 8.6
FSH 1.5 mIU/mL 1.5 - 12.4
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.6 ng/mL 0.0 - 4.0

Still wondering if I should pursue Clomid before the Test, and/or if there would be benefit to checking prolactin and Vitamin D as well.

[sparverius]

Why is your FSH and LH low? Have you been checked for a brain tumor?

Your doctor should have spotted that.

If they can't be fixed you may want to do HCG instead of T. HCG mimics LH and keeps the tescticals producing T.

[TakeTwo]

Why is your FSH and LH low? Have you been checked for a brain tumor?

Your doctor should have spotted that.

If they can't be fixed you may want to do HCG instead of T. HCG mimics LH and keeps the tescticals producing T.

That's what I'd like to know. He pointed it out as a possible pituitary issue, but nothing was said about a brain tumor. That's why I wanted to get prolactin checked, but he's not interested in doing much beyond looking into Clomid and prescribing T. I don't know if my PCP would check it.

From reading the stickies, it sounds like I really need prolactin (with an MRI if indicated), Vitamin D, and a thorough thyroid panel done before doing anything else. I've had my thyroid checked several times in the past whenever I complained about fatigue to my PCP, but I don't know if it was a complete panel.

If LH/FSH are low but prolactin is normal, what would be the next step? Or if prolactin isn't normal but the MRI is, what would be best? Whether I do Clomid or HCG, it sounds like pinning Test from the word go might not be the best idea.

[Low Testosterone]

When most doctors say pituitary issue in reference to low testosterone, they're simply referring to the patient being secondary. They are not stating you have a tumor. Low LH and FSH output is the most common reason for low testosterone and that being due to a tumor is the most infrequent or rarest cause of low testosterone. Does it hurt to have an MRI? Of course not, but if we're going by odds the odds are not in favor of a tumor by any means.

Your doctors prescription - I agree on holding off on the anastrozole. At this stage you have no reason to take it. Some like the idea of beating the aromatization to the punch but it doesn't really work that way. You may not need any anastrozole at all on TRT, so no point in taking it until you see how things work. Followup blood work in 6-8wks to see how things are going would be good. I would also recommend that you stick with 150mg/wk of testosterone. If it needs to be lowered the doctor will lower it after your followup blood. Start playing with it on your own and this is a good way to really irritate your doctor and that never works in your favor. HCG, based on your blood work you'd be a good candidate IMO and there are more benefits than staving off testicular atrophy...in my opinion, preventing testicular atrophy is the least of the benefits and is merely cosmetic related. Regardless, odds are you'll experience atrophy and it sounds like your doctor will RX HCG at that point.

Restarting your natural production - It is possible but at 35yrs old it's unlikely.

Blood getting thick - around 10% of all men on TRT benefit from donating blood. Most do not have to donate as they do not experience above and beyond levels of RBC, hematocrit and hemoglobin. You should have a CBC on each followup blood test, which will cover all these things. If hematocrit is up beyond what's recommended, donate blood. If this happens, do not freak out. You're not going to have a heart attack or stroke just because those numbers were up for a little bit. They have to be elevated for a good while to cause a problem.

Side note to others - A bit of a repeated comment but worth repeating IMO. Ranges do not tell us anything. The unit of measurement is important but 250 ng/dl is always 250 ng/dl regardless of the range beside it. The range changes nothing and is a rather arbitrary number.

[lovbyts]

When most doctors say pituitary issue in reference to low testosterone, they're simply referring to the patient being secondary. They are not stating you have a tumor. Low LH and FSH output is the most common reason for low testosterone and that being due to a tumor is the most infrequent or rarest cause of low testosterone. Does it hurt to have an MRI? Of course not, but if we're going by odds the odds are not in favor of a tumor by any means.

Your doctors prescription - I agree on holding off on the anastrozole. At this stage you have no reason to take it. Some like the idea of beating the aromatization to the punch but it doesn't really work that way. You may not need any anastrozole at all on TRT, so no point in taking it until you see how things work. Followup blood work in 6-8wks to see how things are going would be good. I would also recommend that you stick with 150mg/wk of testosterone. If it needs to be lowered the doctor will lower it after your followup blood. Start playing with it on your own and this is a good way to really irritate your doctor and that never works in your favor. HCG, based on your blood work you'd be a good candidate IMO and there are more benefits than staving off testicular atrophy...in my opinion, preventing testicular atrophy is the least of the benefits and is merely cosmetic related. Regardless, odds are you'll experience atrophy and it sounds like your doctor will RX HCG at that point.

Restarting your natural production - It is possible but at 35yrs old it's unlikely.

Blood getting thick - around 10% of all men on TRT benefit from donating blood. Most do not have to donate as they do not experience above and beyond levels of RBC, hematocrit and hemoglobin. You should have a CBC on each followup blood test, which will cover all these things. If hematocrit is up beyond what's recommended, donate blood. If this happens, do not freak out. You're not going to have a heart attack or stroke just because those numbers were up for a little bit. They have to be elevated for a good while to cause a problem.

Side note to others - A bit of a repeated comment but worth repeating IMO. Ranges do not tell us anything. The unit of measurement is important but 250 ng/dl is always 250 ng/dl regardless of the range beside it. The range changes nothing and is a rather arbitrary number.

Somewhere I'm missing where he asked if an MRI hurt or did it get edited out? I have fallen asleep while getting an MRI, not only am I not claustrophobic close spaces comfort me and so does the loud thumping sound.

[Low Testosterone]

Somewhere I'm missing where he asked if an MRI hurt or did it get edited out? I have fallen asleep while getting an MRI, not only am I not claustrophobic close spaces comfort me and so does the loud thumping sound.

The response wasn't related to physical pain but rather is it a good idea or not, that's all.

[TakeTwo]

When most doctors say pituitary issue in reference to low testosterone, they're simply referring to the patient being secondary. They are not stating you have a tumor. Low LH and FSH output is the most common reason for low testosterone and that being due to a tumor is the most infrequent or rarest cause of low testosterone. Does it hurt to have an MRI? Of course not, but if we're going by odds the odds are not in favor of a tumor by any means.

Your doctors prescription - I agree on holding off on the anastrozole. At this stage you have no reason to take it. Some like the idea of beating the aromatization to the punch but it doesn't really work that way. You may not need any anastrozole at all on TRT, so no point in taking it until you see how things work. Followup blood work in 6-8wks to see how things are going would be good. I would also recommend that you stick with 150mg/wk of testosterone. If it needs to be lowered the doctor will lower it after your followup blood. Start playing with it on your own and this is a good way to really irritate your doctor and that never works in your favor. HCG, based on your blood work you'd be a good candidate IMO and there are more benefits than staving off testicular atrophy...in my opinion, preventing testicular atrophy is the least of the benefits and is merely cosmetic related. Regardless, odds are you'll experience atrophy and it sounds like your doctor will RX HCG at that point.

Restarting your natural production - It is possible but at 35yrs old it's unlikely.

Blood getting thick - around 10% of all men on TRT benefit from donating blood. Most do not have to donate as they do not experience above and beyond levels of RBC, hematocrit and hemoglobin. You should have a CBC on each followup blood test, which will cover all these things. If hematocrit is up beyond what's recommended, donate blood. If this happens, do not freak out. You're not going to have a heart attack or stroke just because those numbers were up for a little bit. They have to be elevated for a good while to cause a problem.

Side note to others - A bit of a repeated comment but worth repeating IMO. Ranges do not tell us anything. The unit of measurement is important but 250 ng/dl is always 250 ng/dl regardless of the range beside it. The range changes nothing and is a rather arbitrary number.

All great information. Thank you. At this stage, I guess I'm just wondering about the "why" in the situation--i.e., why is my pituitary producing low levels of LH and FSH, which appears to be in turn causing my low T? Are there are diseases/diagnoses beyond a tumor that would cause low levels?

I agree that from reading the forum, AI is not always needed while HCG is probably inevitable. It looks like the doctor just wants to be 100% sure symptoms show before RXing it, which I don't have a big problem with. I've also read some people have used HCG by itself (monotherapy) to increase LH/FSH, but I'm not sure what the downsides to that would be. I think that's also a "for life" choice, but it would keep other hormones in check and still allow for a natural test production. Is this worth exploring?

I'll add two possible variables to my situation, which are purely anecdotal and not based on any hard evidence: as a kid, I'd say from birth to teens, I was taking substantial doses of prescription hydrocortisone ointment to treat a nasty case of eczema. I don't know if that's ever been shown to have a hormonal effect, though I'm sure it can probably mess with adrenals/cortisol. I've been off for years, but did take a year's worth of Prednisone about 12 years ago.

Variable #2 would be a significant amount of stress in my life, which may have affected adrenals/cortisol. But again, no idea if that ties into LH/FSH or not. I appear to be secondary hypogonadal, which is what it is, but being hyper-analytical, it would be nice to know why.

[kelkel]

a tumor is the most infrequent or rarest cause of low testosterone.

Just proves that I'm special! Mom always said so.

[TakeTwo]

Kelkel: I've read a lot of your posts and you seem extremely knowledgeable. Any advice?

[Low Testosterone]

Just proves that I'm special! Mom always said so.

All mom's say it, but you're right, apparently it's so with you.

Just to clarify, I wasn't implying in the past post that tumors don't cause lowT or are never an issue.

[Low Testosterone]

All great information. Thank you. At this stage, I guess I'm just wondering about the "why" in the situation--i.e., why is my pituitary producing low levels of LH and FSH, which appears to be in turn causing my low T? Are there are diseases/diagnoses beyond a tumor that would cause low levels?

I agree that from reading the forum, AI is not always needed while HCG is probably inevitable. It looks like the doctor just wants to be 100% sure symptoms show before RXing it, which I don't have a big problem with. I've also read some people have used HCG by itself (monotherapy) to increase LH/FSH, but I'm not sure what the downsides to that would be. I think that's also a "for life" choice, but it would keep other hormones in check and still allow for a natural test production. Is this worth exploring?

I'll add two possible variables to my situation, which are purely anecdotal and not based on any hard evidence: as a kid, I'd say from birth to teens, I was taking substantial doses of prescription hydrocortisone ointment to treat a nasty case of eczema. I don't know if that's ever been shown to have a hormonal effect, though I'm sure it can probably mess with adrenals/cortisol. I've been off for years, but did take a year's worth of Prednisone about 12 years ago.

Variable #2 would be a significant amount of stress in my life, which may have affected adrenals/cortisol. But again, no idea if that ties into LH/FSH or not. I appear to be secondary hypogonadal, which is what it is, but being hyper-analytical, it would be nice to know why.

The majority of low testosterone patients are secondary, not primary, which means low LH and FSH production are what's most common.

The most common reasons of low testosterone other than age:

1. Prior anabolic steroid use
2. Prior or existing rec drug use
3. Prior or existing pain med use
4. Prior or existing antidepressant use
5. Prior or existing statin or BP med use
6. Heavy and long term exposure to corticosteroids
7. Heavy/excessive alcohol consumption
8. Long terms consumption of petrochemicals
9. Long term use of prescription sleep meds
10. Poor/unhealthy lifestyle - lack of sleep, bad diet, infrequent eating, bad food choices, sedentary, etc.

Any of these things can cause a drop in testosterone, 1-9 severely reducing the production of LH and FSH. When you say yes to any two of those you're going to be in bad shape but often it only takes one, especially 1-4.

And of course there are young (under 30) guys with genetic conditions that we all hear about but that's a different story. However, some of them fall in the same categories as over 30 due to the above list. In all cases as this, there isn't some marker that we can look at like a tumor and say "that's what's causing your low testosterone without a doubt." But we do know those items have that affect and that treatment corrects it (as long as you're on treatment. Which begs another point, the old phrase "treatment is for life" implying you cannot stop. This is a bad phrase and simply isn't true. If you start TRT it should be because you need it. If you need it and stop, your natural production will start back up again but it will only take you to where you were before. You'll still have low levels but there isn't anything beyond that that happens should you have to stop.

[kelkel]

Just to clarify, I wasn't implying in the past post that tumors don't cause lowT or are never an issue.

I know you weren't.

[spacemon]

Interesting that sleep meds can cause lower t levels. I never knew that.

[kelkel]

Kelkel: I've read a lot of your posts and you seem extremely knowledgeable. Any advice?

I can't think of anything that doc Low T did not address other than maybe a further look into your thyroid. I believe your doc said it was "ok" but that would not satisfy me quite honestly. Too many doc's judge thyroid via TSH alone which is a weak indicator of thyroid health.

[TakeTwo]

Bumping this thread as I'm still debating starting TRT and ordered an additional test before getting a second opinion in early September: a 24-hour cortisol test with DHEA/DHEA-S.

Cortisol
06:00 - 08:00 AM 20 Normal (13-24 nM)
11:00 - 1:00 PM 3 Depressed (5-10 nM)
04:00 - 05:00 PM 3 Normal (3-8 nM)
10:00 - Midnight <1 Depressed (1-4 nM)

Cortisol Load: 27 (22 - 46 nM)

DHEA Dehydroepiandrosterone Free [DHEA + DHEA-S]
Pooled Value 2 Depressed (Adults (M/F): 3-10 ng/ml)

According to the lab, my DHEA level puts me in Adrenal Fatigue territory using a Cortisol/DHEA Correlation chart. "This zone represents a fatigue or suppression of the adrenals with overt deficits in either or both cortisol and DHEA production. Individuals with suppressed hypothalamic pituitary axis due to exogenous steroid overuse may also show results that fall in zone 7."

So--anything to extrapolate from this? My cortisol doesn't seem too out of whack, but my DHEA is in the crapper. Is this additional proof I have a hypothalamus issue? Would I benefit from DHEA supplementation with or without TRT?

[lancerevo]

There's tons of great resources out there for adrenal fatigue

Life extension has some great articles

Comprehensive Adrenal Fatigue Article - DrLam® - Body. Mind. Nutrition® is also a good one

Adrenal Fatigue and Hormone Therapy - DrLam® - Body. Mind. Nutrition®

For starts, take Fish oil, at least 2g of Vitamin C, and supplement with DHEA. Also try to meditate, deep breath, relax get good sleep and recheck your levels.

Would also help to get FULL thyroid blood work. My cortisol levels and DHEA levels were absolute crap as well just like yours, and my reverse T3 was elevated, which was the only abnormal value. I started taking Iodine and I feel like a whole new person. You can refer to my thread that i started for more detailed log.

[The_Crawfish]

Your cortisol IS out of whack for our age (I'm same age as you). Do you snore and/or stop breathing at night? Ever been checked for sleep apnea??

[TakeTwo]

I had sleep studies done years ago when I first got fatigued. Nothing showed up. I read Lance's links (thank you, by the way) and it doesn't seem there's any surefire method for getting the adrenals back in shape. I definitely will explore my thyroid and pituitary in detail with an endo in a couple weeks.

[TakeTwo]

Well, saw the endo today, and it was a mixed result. He was very patient and accommodating, taking over an hour to explain things and answer my questions--all from bloodwork he hadn't even ordered! (I'm used to doctors staring at their chart before ushering me out in five minutes.)

Basically, I laid out that I had a DX of hypogonadism and wanted to see if I needed to explore my HPTA further before embarking on TRT. He explained that because my basic thyroid test (TSH and T4) was normal, exploring T3 or free T3/T4 wouldn't provide any additional information. He did indulge my request for a prolactin measurement but doesn't think my pituitary is abnormal.

Essentially, his attitude was that there's something wrong in the brain prompting the low T, but nothing worth investigating in the absence of other abnormalities in the bloodwork. He said to take the T and if I feel better, great. If not, taking it for a few months and stopping ultimately won't leave me any worse off.

I did mention my sister having a stroke last year, which gave him pause (she was on estrogen), but I plan to take a Factor V Leiden test to rule out any clotting disorders. (According to Glueck's research, Factor V is an automatic brake on any TRT due to clotting risks.)

He said Vitamin D deficiency is still poorly understood and testing for it wouldn't do much: if it were normal, I still have low T, and if it weren't, well, lots of people are deficient and it may not necessarily be the cause of it.

Thoughts? I know my primary won't order any tests beyond Factor V, so if I want to look at my thyroid--and I'm not sure what that would tell me or how it would change things--I'd be paying out of pocket for a private lab.

[Baxter35]

TakeTwo, I completely understand your concerns and I think you are being smart to take it slow, educate yourself, and explore your options. Having said that, I think it sounds like you should really consider starting the trt. From what you've said about how you feel and general quality of life I think you have much more to gain than lose. Don't let the media scare you away from testosterone therapy, you aren't going to spontaneously combust as soon as you take it. Ideally, you're only going to be taking enough to replace a hormone that your body should have naturally anyway. Most of the risks you're worried about are really much rarer than what they're made out to be. The most likely problem is increased estrogen, and that is easily managed with proper bloodwork and doesn't have to be that big of a deal. Hcg is a good option, but certainly not required and I think its fine to go with your doctors recommendation for both HCG and an AI. I can tell you I started trt almost a year ago now and for all the worrying I did prior I wish I'd started sooner. I literally feel like a completely different person than I did a year ago. Best of luck, and I hope you find a solution you're happy with.

[thisAngelBites]

I know my primary won't order any tests beyond Factor V, so if I want to look at my thyroid--and I'm not sure what that would tell me or how it would change things--I'd be paying out of pocket for a private lab.

There has been some research that suggests that men with hypothyroidism have less production of LH in response to gonadotropin releasing hormone. This is the first step in T production that is therefore impaired.

Hypothyroid men seem to have lower free T levels than men who are not hypothyroid, and treating the hypothyroidism often increases the T levels. You might still need to take T, but perhaps not as much (which would be good, as this could potentially reduce sides like clotting). Thyroid effects almost everything in the body, so I think it's better to get your thyroid where it needs to be if it is an issue, so you're not potentially trying to improve thyroid with testosterone without realising it.

Your doctor may be incorrect about your TSH and T4 being normal, regardless of them being in the reference ranges, which is why Kelkel asked about them. The doc is incorrect that free T3 and T4 would not provide additional information. It can tell about how your body converts the inactive form of the hormone into the active T3 form. Some people do not convert well, and you cannot tell this from TSH or total T4, and you can also not tell how much of those hormones are unbound and available for conversion or use.

[TakeTwo]

Thanks Baxter and Angel for the responses. I've done a ton of research, but thyroid mechanisms are still something I'm constantly having to review because I can't seem to keep it all straight. I believe the endo's assertion was that if something was abnormal with free T3/T4, then TSH would be elevated in response. He also believed I exhibited no outward symptoms of hypothyroid (beyond fatigue). Looking online, I seem to have just one foot in that field: occasional puffy face, poor memory, and exhaustion, but no muscle ache, dry skin, or slowed heart rate.

I may just order the tests privately to put it all to rest. The problem is, to acquire a real-world DX of hypothyroid, most endos would just look at TSH and probably not even regard private lab results. Still, since he was amenable to looking at my own labs, maybe this guy would reconsider. I'll at least get prolactin done this week, but since TSH is thought to be more of a pituitary marker, I don't think it'll be an issue. I guess I'll know more soon.

EDIT: Just so I'm clear, I want to order/request free T3, free T4, and reverse T3, correct? I already have TSH and T4. Do I need to search out a T3 (not free) value, or will those first three tests be sufficient?

[thisAngelBites]

I believe the endo's assertion was that if something was abnormal with free T3/T4, then TSH would be elevated in response.

This is incorrect, and I am one of the people that demonstrates its incorrectness. My TSH is low (lower than 1), and my free T3 and T4 are both low. I have frank hypothyroid symptoms when I lower my dose of dessicated thyroid that resolve when the thyroid dose is increased, but do not resolve with any other interventions. I don't know why my pituitary thinks I have enough thyroid hormone when I do not, but I do know it's wrong. So I don't know how your doc would make sense of my case, when he thinks it is impossible.

There is a fair amount of concurrence with low T and thyroid, so that makes it worth checking, in my opinion. Look, you may not have any thyroid problem, and of course fatigue is a very non-specific symptom, but if you start with T, and encounter any need to tweak (which you will, in all likelihood), or have a lack of abatement of symptoms you are always going to have to wonder if thyroid is complicating things. It's better to have it as a baseline, although I sympathise with having to cover the cost of tests yourself.

And you do not need total T3, just the three you mentioned.

[TakeTwo]

Angel: thanks. And I agree it's worth investigating. I just wish this was better understood by the medical community at large so I didn't have to keep digging in my own pockets for testing.

[Baxter35]

Angel: thanks. And I agree it's worth investigating. I just wish this was better understood by the medical community at large so I didn't have to keep digging in my own pockets for testing.

I guess I didn't notice your questions regarding thyroid the first time I read through this. I can also chime in with some personal experience. There is definitely a very common correlation between hypothyroid and low T. It doesn't mean you are hypo..but it makes it a very relevant test before starting treatment. When I was getting tests done before starting TRT, my thyroid functions were still within normal ranges but only barely. At the time, the decision was made not to treat thyroid yet and re-check in 6 months. I started TRT, started feeling a ton better, and went in for thyroid tests 6 months later expecting everything to come back great since I didn't feel that I ever had any classic hypothyroid symptoms. Nope, my TSH was above 10 and free T3/T4 were both less than 1. Would treating my undiagnosed hypo have helped my low T prior to starting treatment? My endo doesn't think so, but I'll never know for sure. My only point is that you can be hypothyroid without many symptoms, and again, it commonly goes with low T. And also, treating low T alone will not improve you thyroid if there is an issue, so you need to at least know where you thyroid counts are. For now, I'm only being treated with Synthroid(T4) for my hypo, and we'll re-check everything in a couple more months to see if I respond properly to T4 alone or if I need to supplement T3 as well. I don't see why your doctor would have a problem with running a full thyroid panel. It is a very common problem and especially for someone with Low T diagnoses. Have you asked to know for sure if they will order a fresh round of thyroid tests?

[TakeTwo]

I don't see why your doctor would have a problem with running a full thyroid panel. It is a very common problem and especially for someone with Low T diagnoses. Have you asked to know for sure if they will order a fresh round of thyroid tests?

Yes, though I did put in an email request via a patient portal as one hlast hail-mary before paying for it myself. His assertion was that there was no benefit to checking free T3/T4 because he had no reason to believe I was hypothyroid, and that other panels would be out of range if I were. (He called my cortisol/DHEA "normal.") Looking at the clinical notes from the visit, he did diagnose me with "pituitary disorders anterior part other." So---okay, then.

Honestly, I've "argued" with doctors for so long for a myriad of reasons that I've lost patience. He admitted HPTA/hormones were "poorly understood," which is at least an acknowledgment that it's a complex issue. Ultimately, it's just practicing medicine in the most literal sense of the word.

My intentions at this point are to get Free T3, Free T4, Reverse T3, prolactin, genetic clotting markers (Factor V Leiden, Factors VIII and XI) and possibly a re-test of my free and total T to confirm the DX before starting T. I also have my adrenals to deal with, which appear to be a hot mess.

[Baxter35]

Sucks to pay out of pocket, but I guess if that's what must be done its better than not testing if only for piece of mind. I'd still push a little more first though. I disagree with his statement that other parameters would be out of line. I've had numerous full blood panels done over the last 10-11 months, and other than the thyroid numbers themselves, there is nothing else to suggest low thyroid. That may have changed if gone untreated even longer, but for now everything else looks good.

[TakeTwo]

Good news: he actually agreed to the additional thyroid tests. (Sometimes I'm too cynical for my own good.) Will update when results are in. Thanks for the extra push, Baxter.

[thisAngelBites]

Really glad to hear it.

[TakeTwo]

Update! Finally got thyroid results back from the endo. No reference ranges, as this was via email, and he may call to discuss. Nurse just said they were the "low end of normal."

TSH: 0.81
T4: 0.96 ng/dl
Free T3: 2.9 pg/ml
Free T4: 1.00 ng/dl
REVERSE T3: 17.3
PROLACTIN: 4.3 ng/dl

Can anyone translate for me? Any thyroid/pituitary alarm bells going on?

Edit: doctor phoned to say that by his estimation, all thyroid functioning is normal. Prolactin is apparently only a concern if it's very high. He had no interest, really, in the Free tests and was surprised Reverse T3 was done (by my request).

[TakeTwo]

One more update. Hoping someone can chime in.

Had bloodwork done Monday in advance of a phone consult next week for a second (really, third) opinion before starting therapy, and I think I'm more confused than ever.

Test: total is now sitting at 498 ng/dL, or basically double what it was in late May. Free is 9.6, up from 6.1. LH also doubled, from 1.4 to 2.8. Estradiol, which I had never measured before, is 29.2 (ref. range 7.6 to 42.6). Magnesium 1.8 (range 1.6 to 2.6 mg/dL).

I went from old-man numbers to seemingly average for my age in a four-month span. In that time, a few variables were at work:

- I started lifting again (3x/week, heavy weights and low reps) and also added some interval training 2x/week. Had ten weeks of this under my belt prior to Monday's tests.

- Got more protein and a little less junk in the diet.

I still obviously have some adrenal/thyroid issues to address, but now I'm thinking TRT is no longer indicated. Any thoughts welcome.

(Note: both draws were done at roughly the same time of day, fasted, not having "released" in the 24 hours prior, and at the exact same LabCorp location.)

[OingoBoingo]

You might want to do some research on Finasteride.

Nasty stuff with the possibility of life-long sides.