FT4 levels on tests and brain fog

[JoeMatts]

@JoeMatts

Had another blood test drawn today where FT4 came back at 12.8 pmol/l (range 10.5 - 24.5). I've had two before with 15.1 and 15.8. I'm not too thrilled about how low it is but I'm also very hesitant to intervene with that.

12.8 pmol/l is very low, but how do you actually feel apart from the fatigue? Do you have symptoms of low thyroid function, like: low body temps, thinning hair and/or eyebrows, impaired digestion, dry skin, etc?

Thyroid treatment alone is less inconvenient than trt in my opinion, so there'd be no harm in trailing low dose NDT or levothyroxine, slowly working up the dose. That's assuming you do actually have other hypo symptoms — no point treating a number if you feel fine.

 

[JoeMatts]

So did you give up on TRT due to symptoms? Excess aromatisation/anxiety/irritability/depression/something else?

How long did you give it before quitting and with what level of AI if any?

Edit: Also you're aware that E2 suppresses T4 -> T3 conversion, and that inflammation suppresses the thyroid and increases aromatisation, whereas testosterone decreases many inflammatory markers?

I haven't heard the case of TRT crashing cortisol before though. Personally I believe my issue is primarily an issue with inflammation (and possibly the immune system). I had fatigue that was absolutely wrecking me before TRT and I feel best with TRT and adequate AI with regard to that.

I stopped trt because it made the vast majority of my existing issues worse, as well as contributing various issues of its own. I took it for four years, with bloods and protocol adjustments every twelve weeks, so I gave it plenty of time. The protocol rarely made a difference in how I felt.

I don't want to say trt dropping cortisol is common, but I've seen it alot and, from a physiological view, it's almost expected given cortisol and testosterone are inversely related. I'm aware of e2's suppression of T4 -> T3 via upregulation of TBG; my issue was never with conversion, but more so the lack of absolute output from the gland.

Testosterone itself is anti-inflammatory, but it's suppression of cortisol would cause my crp and esr to go through the roof — both of which return to normal with cessation. I'll probably try trt again at some point, but only when my thyroid and adrenal issues are solved.

 

[trtthings]

12.8 pmol/l is very low, but how do you actually feel apart from the fatigue? Do you have symptoms of low thyroid function, like: low body temps, thinning hair and/or eyebrows, impaired digestion, dry skin, etc?

Thyroid treatment alone is less inconvenient than trt in my opinion, so there'd be no harm in trailing low dose NDT or levothyroxine, slowly working up the dose. That's assuming you do actually have other hypo symptoms — no point treating a number if you feel fine.

If you're interested in some reading that I find fascinating (regarding FT4, FT3 and mood): SAGE Journals: Your gateway to world-class research journals

Not trying to sell you on this particular drug, but rather that reading the results/discussion is interesting.

Esp. the part where high FT4 often seems to correlate to higher HAM-D scores, and lower FT4 lower scores, and higher FT3 with lower scores.

My symptoms.. digestion is trash, and yes, sensitivity to cold as well. Not noticed much thinning. Very dry skin (esp. notable on head). The worse thing I deal with now is my mood, I get really emotional (which has never been a problem before). Anastrozole helps with that bit but mood in general could be a lot better.

Interesting to hear WRT CRP and ESR. I know someone who suffered from insane fatigue for 12 years (much worse than I, bedbound), who started TRT and anastrozole (a hefty dose of the latter). He started feeling better right away but had a period after a few months where CRP went through the roof. He kept to his protocol and added some supplements and now several years later he still feels fine/great.

I've considered trialing thyroid meds (esp. T3) but I've been reluctant to suppress that axis. Plus it sounded like a pain to balance. If you take too much you'll feel jittery, and so on. It's interesting though to read that adding T3 to some antidepressants turns non-responders to responders.