Thyroid or T - Problems?

[M!ck]

Hi, not sure where to go.
Symptoms: low energy, fatigue are my biggest. followed by no libido, cold hand & feets + brainfog.

labs show following:

TSH - 0.79 ( Ref 0.3 - 3.18)
fT3 - 4.65 (Ref 4.09 - 6.65)
fT4 - 16.8 ( Ref 13.1 - 21.3)

Testosteron 3.86 ( Ref 2.49 - 8.36 )
SHBG 23.5

Endo said it all looks good, but to me it could be higher in T and the fT3 is kind ow low?
Had a t-replacement 2 years ago for 1.5 years, but stopped due to high HCT.

Not sure where to follow up now. Start t-replacement again, or going to an Thyroid specialist.
About me: Age 42, living healthy, no smoking or alcohol, gym 3-4 times a week since 20+ years.

Appreciate any advise. Thanks.

 

[Vince]

Any issue with sleep? I recently got a Fitbit watch to track my sleep.

 

[M!ck]

Snoring when I'm not sleeping on my right side. Otherwise i did a home sleep study last year which resulted in "only" 1 breathing stop per hour. Which was fine the doc said.

 

[Golfboy307]

You need to understand your Free T levels, that is what counts. Along with E2.

 

[M!ck]

17ß-Estrogen 18.1 ( Ref. 11.3 - 43.2)

my calculated free T is not that bad (total T in relation with low SHBG)
Meassured free T in 2019 had been 7.01 (Ref. 8.3-40.1)

So whats your opinion on that calculated vs meassured?

 

[Golfboy307]

You will find lots of opinions on this site about which assay to use, vs. calculated. It's your symptoms that matter more. Based on your info above, you should certainly consider going back on T therapy.

 

[Systemlord]

Testosteron 3.86 ( Ref 2.49 - 8.36 )
SHBG 23.5

Endo said it all looks good, but to me it could be higher in T and the fT3 is kind ow low?

Some doctors are overly fixated on the lab numbers and don't understand how hormones work. You don't become symptomatic at 2.48, and at 2.50 you feel like superman, the symptoms occur on your way down the normal range.

You can be low normal, even mid normal and still have a degree of symptoms, that get progressively worse as levels drop further.

The majority of endocrinologists are out to lunch in the TRT arena. Your endo didn't even bother testing the Free T, which could be below normal.

Studies show symptoms can develop<500 ng/dL.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter syndrome, ...

www.ncbi.nlm.nih.gov

The prevalence of hypogonadal symptoms increases with TT levels below 12.1 nmol/L (350 ng/dL) [26] (Level 2b, Grade A). However, Zitzmann et al. have shown that testosterone deficiency symptoms may also be seen with TT levels as high as 15 nmol/L (433 ng/dL). This study showed that the prevalence of loss of libido or vigor increased at testosterone concentrations below 15 nmol/L or 433 ng/dL.

 

[M!ck]

Thanks @Systemlord for that link. Good to have an official document stating that my numbers are not ideal.
Before my trt back in 2019 I was having levels between 2.0 and 2.9 and i can tell the difference. With that low levels symptoms had been worse.