Thyroid, Adrenal Fatigue, DHEA? Advice Please!

SuperTonky

New Member
The short story is that meet Total test is about 600 on 100mg IM every 5 days. I still have alot of anxiety, mood issues, tremors, fatigue, Ed, sleep issues, blood pressure high, etc. I am even having some hoarseness in my throat near my thyroid. I'm trying to look at other hormones that could be contributing or my thyroid. I'm also looking into the possibility not adrenal fatigue, pregnenolone steal, or supplementing with HCG. m pretty lost in all the info. A more detailed history below.

At age 33, After years of depression, anxiety, fatigue, weight gain, sleep problems, ed, etc. I convinced my doctor to test my hormones. I was specifically interested in my Cortisol levels due to prolonged profound amounts of physical anxiety. The results of what he tested were;

Total Testosterone: 95 ng/dl (300 -1080)
TSH: 3.64 uIU/ml (0.30 - 3.18)
Free T4: 1.6 ng/dl (0.8 - 1.7)
LH: 3.4 IU/L (2.0 - 12.0)
FSH: 3.9 IU/L (1.0 - 8.0)
LDL: 152 ng/dl (0 - 130)
HDL: 40 mg/dl (> 40)
Chol/HDL Ratio: 5.5 (0 - 5.0)
Cholesterol: 218 ng/dl (0 - 200)
Cortisol: 14.0 ug/dl
Glucose: 88 mg/dl (70 - 99)
Iron: 66 ug/dl (50 - 150)
Iron Sat: 19% (20 - 50)

Doctor said my test was a little low and that the other out of reference results were not far enough to mean anything. He said to start on a very low dose of topical test. He couldn't answer most of my questions so I went somewhere else.

The Testosterone Clinic put me on 200mg of injectable Test Cypionate a week. And a small amount of HCG. After a few months I felt better than I had in 10 years. Energy, mood, and sleep were all much better. My Total Testosterone was usually about 500 ng/dl when due for the next injection. When I started having symptoms of what I later discovered was high Estradiol the clinics answer was to raise the Test to 220mg per week. Obviously my Estradiol went up higher, to 79 pg/ml (10-40) by the time we tested. Used Anastrozole to get it back down to 30 pg/ml. Then had Hematocrit and Hemoglobin increases. The whole time I had a terrible last 2 days before the next injection. I wanted to try more frequent dosing at smaller amounts but the clinic's business model wouldn't allow it.

Went to an Endocrinologist. She said she doesn't believe in HCG or AI use in men. Got an MRI on my Pituitary that didn't show anything. She cut my Test dose to 100mg per week. All of my symptoms returned. She tested me 2 days after my injection and Total Testosterone was 450 ng/dl. She said as long as I was above 300 ng/dl then it's not the problem. Said she couldn't do anything else for me and she wouldn't budge on dosing.

Went to a Urologist. He allowed me to try 100mg of Test every 5 days. He says he doesn't do HCG because you become desensitized to quickly anyway. My Total Testosterone got up to 609 ng/dl on next injection day. I have been on this dose for about 6 months. I was doing well. Energy was back, sleep was good, lean muscle mass increased. No hematocrit, hemoglobin, or estradiol problems. I had some ED and libido issues however. I should also mention I started a Blood Pressure medication and switched a few times because of these issues. I am on Losartan and Amlodipine because my doc said they are least likely to contribute to ED.

If you are still reading, bless you, and to get to the point of where I am now. I am still taking 100mg (.5ml of 200mg/ml Test Cypioniate) every 5 days. I take a multi vitamin and vitamin D (4000IUs a day) supplement. Still on the blood pressure meds. My most recent labs were Total Test 609 ng/dl and Estradioal 40pg/dl. For the last few months I have had an incredible amount or anxiety, depression, fatigue, brain fog, sleep quality is bad, ed and libido issues. My testicles are noticeably smaller, and my penis seems to be smaller most of the time especially in girth.

My Urologist said he cant do anything but his Physicians Assistant recommended I get my Total Test up to at least 800 ng/dl to rule it out as a cause. I've been reading a lot about Pregnenolone Steal, the role of DHEA, Progesterone, DHT and so many other things. I have read how HCG can mimic some upstream hormones as well. I can't tell you how profound my physical anxiety has been. My moods are terrible, my brain is so foggy, and the fatigue seems to be getting worse as the anxiety persists.

Does anyone have any advice? Should I try supplementing DHEA, Progesterone, DIM. Should I look for a doc that will prescribe HCG? Does anyone know of a doc that is familiar with and knowledgeable about all of this stuff in the Omaha/Lincoln Nebraska area? Should I look into thyroid or other possible causes? I am so lost with all of the information and so tired of seeing doctors that contradict each other and have no answers.

Sorry I know this is a long and rambling post. If anyone can help or has any questions I can clarify or give additional info. Thanks in advance
 

Mark Saur

Active Member
Good morning! I am so sorry you are struggling! looking at your FT4 at 1.6 I would really want to see a full thyroid panel and include FT3, Reverse T3 and TPO. I think you could have high RT3 if I were to bet. You really cannot get any improvement if you have a thyroid issue. If you have high RT3 you will need to treat it with pure T3 to clear out the RT3. Get with your doctor and you can learn more on Stop The Thyroid Madness website. You need to learn so you can be your best advocate.
 

SuperTonky

New Member
Thanks for the advice and guidance. I have a docs appointment on Friday with a new PCP. Hopefully they will be on board and knowledgeable. I will update if I get any results. Thanks again for your time.
 

Nelson Vergel

Founder, ExcelMale.com
I would check my ferritin. Your iron saturation is low. This may be a cause for your high TSH. I would also add thyroid antibodies to your next bloodwork.
 

SuperTonky

New Member
Thanks everyone so much! My appointment got bumped back to this week. I am bringing all the bloodwork suggestions with me. Hopefully the doc will be on board.
 

JohnTaylorHK

Active Member
Sorry to hear of your problems. It is my experience that thyroid issues are (as mentioned above) more important than one would think. I believe now that improper treatment of this is what may have caused the death of my older sister. There are Total T3/T4, free T3/T4, Thyroid Stimulating Hormone (TSH) plus Antithyroxine Peroxidase/Thyroglobulin AB. The latter 2 are related to thyroid disease itself. Reverse A3 can also be done but it is expensive. The key numbers are Free T3 (the end product) and TSH. Elevated TSH means your pituitary is telling the thyroid to release more thyroxine (T4) which is ultimately converted to T3 and used in parts of the body not just the thyroid. In my case, I am currently taking Lugol's (2 drops initially per night) to increase my iodine. This is a relatively cheap solution for anyone who thinks they may be iodine deficient. I apologise if my understanding above is not 100% technically correct, I am not a doctor. Namaste.
 

SuperTonky

New Member
John, thanks for the info and so sorry about your sister. There seems to be quite a bit of information out there on Thyroid issues and more. I am hoping my new doctor will have a good handle on a lot of it, it's definitely ba bit overwhelming to explore.
 
'Hope' is the operative word. I've encountered few doctors, whether primaries or specialists, who have a substantial knowledge about primary and secondary hypothyroidism. 3, in 26 years. But you do need to keep trying. If that PCP is clueless, check the site of the American Academy of Antiaging Medicine, known as A4M for someone in your area or contact Defy in Tampa. I believe they do telemedicine. You'll have to pay out of pocket for anyone who is knowledgeable. You're not getting good results from testosterone because of thyroid related problems. I stopped testosterone three months ago to focus on thyroid issues and will resume, if necessary. In 1994, lost my erections, gained weight, became depressed and constipated. My psychiatrist told me it was my thyroid and prescribed Cytomel. In two days, my erection was back and all other symptoms also began to resolve. Don't let incompetent doctors ruin your life.
 

dell500

New Member
'Hope' is the operative word. I've encountered few doctors, whether primaries or specialists, who have a substantial knowledge about primary and secondary hypothyroidism. 3, in 26 years. But you do need to keep trying. If that PCP is clueless, check the site of the American Academy of Antiaging Medicine, known as A4M for someone in your area or contact Defy in Tampa. I believe they do telemedicine. You'll have to pay out of pocket for anyone who is knowledgeable. You're not getting good results from testosterone because of thyroid related problems. I stopped testosterone three months ago to focus on thyroid issues and will resume, if necessary. In 1994, lost my erections, gained weight, became depressed and constipated. My psychiatrist told me it was my thyroid and prescribed Cytomel. In two days, my erection was back and all other symptoms also began to resolve. Don't let incompetent doctors ruin your life.
How did you get off TRT? I meant to ask my doc at Defy today but forgot. Been wondering if there's a cut off point for how low testosterone has to be in order to rule it being a thyroid issue or hypogynodasim or possibly both.
 

SuperTonky

New Member
Updating my original post in case anyone is still following interested.

I discussed at length with my new doctor doing in depth testing of my thyroid (TSH/T4/T3/RT4/RT3,TPO, etc) She agreed to. I ended up contracting Covid-19 and had to obviously wait until I was no longer infectious. My doctor also wanted me to wait until I had recovered from my Covid symptoms so they wouldn't interfere with testing. Obviously the problem being throat pain, fatigue, hormone embalance symptoms could all be confused for Covid or ongoing Thyroid issues.

When I eventually felt better I went to get tested and there was a bunch of confusion what tests the doctor ordered and of course they ended up missing most of the tests I thought we agreed on. The results she did test, after I had a reduction in all symptoms, came back as;

TSH: 0.991 UIU/ml (0.4 - 3.80)
T4: 1.3 ng/dl (0.7 - 1.4)
TPO: <28 u/ml (<58)

I asked if the numbers could have been higher when my symptoms were worse and now I am in some recovery or in between state. She wasn't sure. I also asked about the other tests and she said she has never seen them be useful. I asked if I could get an ultrasound because I still had sensation of tightness and sensitivity in my thyroid area, she ordered one. The results were;

Thyromegaly but without suspicious nodules. Small hyperechoic cyst on lower left of left lobe measuring 0.4 cm. The enlarged Thyroid measurements were;

Right Lobe 6.6 x 2.0 x 2.2 cm (4 -6 x 1.3 - 1.8)
Left Lobe 6.0 x 2.2 x 2.4 cm (4 -6 x 1.3 - 1.8)
Isthmus 0.4 cm

The nurse said they don't know why my Thyroid is enlarged and told me to go see an ENT
 

dell500

New Member
Updating my original post in case anyone is still following interested.

I discussed at length with my new doctor doing in depth testing of my thyroid (TSH/T4/T3/RT4/RT3,TPO, etc) She agreed to. I ended up contracting Covid-19 and had to obviously wait until I was no longer infectious. My doctor also wanted me to wait until I had recovered from my Covid symptoms so they wouldn't interfere with testing. Obviously the problem being throat pain, fatigue, hormone embalance symptoms could all be confused for Covid or ongoing Thyroid issues.

When I eventually felt better I went to get tested and there was a bunch of confusion what tests the doctor ordered and of course they ended up missing most of the tests I thought we agreed on. The results she did test, after I had a reduction in all symptoms, came back as;

TSH: 0.991 UIU/ml (0.4 - 3.80)
T4: 1.3 ng/dl (0.7 - 1.4)
TPO: <28 u/ml (<58)

I asked if the numbers could have been higher when my symptoms were worse and now I am in some recovery or in between state. She wasn't sure. I also asked about the other tests and she said she has never seen them be useful. I asked if I could get an ultrasound because I still had sensation of tightness and sensitivity in my thyroid area, she ordered one. The results were;

Thyromegaly but without suspicious nodules. Small hyperechoic cyst on lower left of left lobe measuring 0.4 cm. The enlarged Thyroid measurements were;

Right Lobe 6.6 x 2.0 x 2.2 cm (4 -6 x 1.3 - 1.8)
Left Lobe 6.0 x 2.2 x 2.4 cm (4 -6 x 1.3 - 1.8)
Isthmus 0.4 cm

The nurse said they don't know why my Thyroid is enlarged and told me to go see an ENT
So your thyroid is enlarged and they didn't want to do more blood tests? Odd.
Was that free T4 or total?
I started T3 meds and feel light-years better. The DHEA was definitely causing my fatigue and acne like sh mentioned above.
Hopefully someone else can chime in and help.
Hope you get it figured out. Looking forward to your progress too.
 

SuperTonky

New Member
The T4 was Free.

I was hoping to see my T3 results but they didn't get tested. I think the doc just doesn't really have an idea apart from the few Blood Level average ranges of the basic Thyroid tests. So she is sending me to an ENT. I'm guessing the ENT will end up sending me to an Endocrinologist lol, who knows.
 

dell500

New Member
The T4 was Free.

I was hoping to see my T3 results but they didn't get tested. I think the doc just doesn't really have an idea apart from the few Blood Level average ranges of the basic Thyroid tests. So she is sending me to an ENT. I'm guessing the ENT will end up sending me to an Endocrinologist lol, who knows.
Sounds like the same runaround I had with my primary. Luckily my hormone doc at Defy (Caleb Calkins) got everything figured out. T3 has been a lifesaver. I just started a new job and I have enough energy to withstand the day finally. I hope you get it figured out sooner than later.
 

SuperTonky

New Member
Thanks! I hope so too!

I might end up looking into the telehealth services like you mentioned here if I can't get any answers.
 

SuperTonky

New Member
An update if anyone is still interested. I've had a few more thyroid blood labs. One on 9/28/20 where I felt pretty fatigued, brain fog, depressed, no libido. Another lab on 10/20/20 where I felt more normal.

9/28/20
TSH: 4.9 UIU/ml (0.4 - 3.8)
T4 Free: 1.2 ng/dl (0.7 - 1.4)

10/20/20
TSH Ultrasensative: 2.594 mcIU/ml (0.4 - 4.3)
T4 Free: 1.0 ng/dl (0.6 - 1.6)
T3 Total: 123 ng/dl(87 - 178)
 

JohnTaylorHK

Active Member
So your thyroid is enlarged and they didn't want to do more blood tests? Odd.
Was that free T4 or total?
I started T3 meds and feel light-years better. The DHEA was definitely causing my fatigue and acne like sh mentioned above.
Hopefully someone else can chime in and help.
Hope you get it figured out. Looking forward to your progress too.
Hi Dell500, what T3 meds did you take, dosage etc?
 

dell500

New Member
Hi Dell500, what T3 meds did you take, dosage etc?
I started out with liothyronine (generic Cytomel) 5mcg/day. Doc said 7-10 days and reassess. I did 2-3 weeks at that dose and then went up to 10mcg, which is where I've been for the last month and half. I also changed testosterone esters, propionate instead of cypionate, and my quality of life has exponential increased. I can work now and don't have a lot of the issues I had before. Like gyno, bloating, depression, and libido.
 

dell500

New Member
An update if anyone is still interested. I've had a few more thyroid blood labs. One on 9/28/20 where I felt pretty fatigued, brain fog, depressed, no libido. Another lab on 10/20/20 where I felt more normal.

9/28/20
TSH: 4.9 UIU/ml (0.4 - 3.8)
T4 Free: 1.2 ng/dl (0.7 - 1.4)

10/20/20
TSH Ultrasensative: 2.594 mcIU/ml (0.4 - 4.3)
T4 Free: 1.0 ng/dl (0.6 - 1.6)
T3 Total: 123 ng/dl(87 - 178)
Probably need rT3 and fT3 for a better picture. I was told by my doc that when we have dysfunctional thyroids, we can have episodic waves of good days/weeks and then, like bipolar disorder, be sunken for days/weeks. So this might be what's happening.
 

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