blood work done. Need advice on how to proceed

[cookwg513]

Hi, thanks for sharing your thoughts. I didn't get right back to you as there was a development i was letting play out first. My PCP is Kaiser (Northern California) and it just so happens I was assigned a new Doctor who happened to be an Osteopath. As I was scheduled to meet him yesterday (regrettably because I'd torn up my rotator cuff) I thought I'd wait and get his input regarding my plans. In particular your suggestion regarding re-evaluating the need for Synthroid.

The good news is that he is very supportive of reducing the synthroid and finesteride to the minimum necessary but felt strongly that to really get things dialed in only one variable should be changed at a time. Either reduce the synthroid or the finesteride but not both. That made sense to me.

Furthermore he thought the finesteride was the place to start as the synthroid dose I'm taking is relatively small. As I read your responses I also see that you suspect I'm taking way too much finesteride as well so my current thinking is to wait for my DHT results (blood was drawn last Tuesday, results 8-10 days) and make a final decision based on what input I receive when I post those numbers. As a practical matter I would like my new physician to feel like I'm taking his advice. Although Kaiser isn't going to support HRT in my case, an individual physician can order any blood test he wants. It would be a real advantage for me compared to paying Labcorp out of pocket to have that kind of support.

I'm finding this whole thing quite complex. Thank you so much for taking the time to help those of us who are struggling our way forward!

[Youthful55guy]

Hi, thanks for sharing your thoughts. I didn't get right back to you as there was a development i was letting play out first. My PCP is Kaiser (Northern California) and it just so happens I was assigned a new Doctor who happened to be an Osteopath. As I was scheduled to meet him yesterday (regrettably because I'd torn up my rotator cuff) I thought I'd wait and get his input regarding my plans. In particular your suggestion regarding re-evaluating the need for Synthroid.

The good news is that he is very supportive of reducing the synthroid and finesteride to the minimum necessary but felt strongly that to really get things dialed in only one variable should be changed at a time. Either reduce the synthroid or the finesteride but not both. That made sense to me.

Furthermore he thought the finesteride was the place to start as the synthroid dose I'm taking is relatively small. As I read your responses I also see that you suspect I'm taking way too much finesteride as well so my current thinking is to wait for my DHT results (blood was drawn last Tuesday, results 8-10 days) and make a final decision based on what input I receive when I post those numbers. As a practical matter I would like my new physician to feel like I'm taking his advice. Although Kaiser isn't going to support HRT in my case, an individual physician can order any blood test he wants. It would be a real advantage for me compared to paying Labcorp out of pocket to have that kind of support.

I'm finding this whole thing quite complex. Thank you so much for taking the time to help those of us who are struggling our way forward!

My condolences at having to work through Kaiser, a growing cancer in California. They have very regimented TRT protocols and won't let their doctors stray far from them. My PCP is with a medium sized clinic on the Central Cost and they give their docs a much longer leash.

Having said that, I think you ended up with the best possible choice of docs in your situation. To a certain degree, I also agree with him. If you are basing decisions on symptoms, then adjusting one variable at a time is the right decision. However, I think you could work on both to adjust the levels based on labs to get you within the 50th percentile of the normal range both DHT and thyroid hormone. I suspect you are currently at the higher end of the range for both and that both are contributing to your symptoms. So, just because you lower finasteride and don't feel better (because of the high thyroid hormones/SHBG), it doesn't mean it wasn't the right thing to do, as it will contribute to the overall solution once you adjust the thyroid hormones into the normal range.