Huge drop in testosterone

Normal is a typical MD’s response when they aren’t trained in proper treatment of symptoms versus blood test. You definitely need to concentrate first on lowering your Reverse T3. It needs to be less than 15 as MarkM pointed out. At least you were tested which most MD’s don’t. Here is a great link by a Thyroid expert in how to get it in range:
https://www.restartmed.com/reverse-t3/
Good luck and keep us posted.

MarkM said:

Ranges can be funny things.........they are a range. All your thyroid labs looks within range to some degree or another and there has been discussion within the medical community based on my readings to change them because they are so broad in some cases. In the end it is how you feel and you have symptoms that can be related to low T and a potential underperforming thyroid. If your thyroid antibodies are high it means these antibodies are attacking your normal thyroid tissue preventing it from performing properly. If they are normal then it could be your Reverse T3 interfering with your with Free T3.

It is probably easier to get your testosterone dialed in than your thyroid from what I've learned from others experiences.

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I'll see what the antibodies test says and will report back (although it'll take a couple days). I'm not confident that I have an autoimmune disease, though -- no family histories of either Grave's or Hashimoto's.

I did some reading on lowering RT3. It looks that one of the more aggressive ways to lower RT3 involve increasing T3 and reducing T4. The thing is... increasing T3 also increases SHBG. Wouldn't that be equally as bad?

Orrin Israel said:

You do not need ALL the symptoms to be HYPO.
While I still like "Tiredthyroid" as a 1st stop I am reeeealy starting to be impressed with RESTARTMED for follow-on deeper discussions.
The more sections I read and the more vids I watch to more impressed I am.
Suggest you read this post reference Thyroid:
https://www.restartmed.com/hypothyroidism/

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1Draw said:

Normal is a typical MD's response when they aren't trained in proper treatment of symptoms versus blood test. You definitely need to concentrate first on lowering your Reverse T3. It needs to be less than 15 as MarkM pointed out. At least you were tested which most MD's don't. Here is a great link by a Thyroid expert in how to get it in range:
https://www.restartmed.com/reverse-t3/
Good luck and keep us posted.

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Thanks for the links guys, there's A TON of info there.

A few things stood out to me. For starters, the article mentioned that calorie restricted diets increase reverse T3. For about two years, my caloric intake has dropped significantly. Not intentionally, stopped powerlifting and got way more involved with work. I'd say there's been a roughly 50% drop in calories from early 2016 to now. Even larger for a few months late 2017. Right now, I eat at maintain calories for my current weight. (not sure if its important, but I definitely do not have a slow metabolism)

The second thing, and I touched base on it in my reply to MarkM, is how the article 1Draw linked suggests lowering reverse T3. The article mentions using SHBG as a tool to measure whether thyroid medication is working or not. If you take the medication and SHBG levels increase while estradiol levels remain constants, the medication is working. In the article for lowering reverse T3, the first suggestion is to take T3 medication. Would this not just increase SHBG and cause issues with bioavailable testosterone levels. Fixing one thing, but breaking something else.

Uniquerabbit said:

Thanks for the links guys, there's A TON of info there.

A few things stood out to me. For starters, the article mentioned that calorie restricted diets increase reverse T3. For about two years, my caloric intake has dropped significantly. Not intentionally, stopped powerlifting and got way more involved with work. I'd say there's been a roughly 50% drop in calories from early 2016 to now. Even larger for a few months late 2017. Right now, I eat at maintain calories for my current weight. (not sure if its important, but I definitely do not have a slow metabolism)

The second thing, and I touched base on it in my reply to MarkM, is how the article 1Draw linked suggests lowering reverse T3. The article mentions using SHBG as a tool to measure whether thyroid medication is working or not. If you take the medication and SHBG levels increase while estradiol levels remain constants, the medication is working. In the article for lowering reverse T3, the first suggestion is to take T3 medication. Would this not just increase SHBG and cause issues with bioavailable testosterone levels. Fixing one thing, but breaking something else.

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Sure it's a double edge sword, but the proper course of action is to throw more androgens to manipulate it, larger injections (excess androgen activity) will lower SHBG and at the same time more Free T3 will speed up every cell in your body. A TRT protocol for a high SHBG guys is 1-2 large injections a week, whereas a TRT protocol for a low SHBG guy is small micro injections multiple times a week so you don't hammer SHBG that is already low.

I know bigger less frequent injections are common advice for high SHBG guys, but has this ever been confirmed? I've personally never seen a study saying this, and I've read multiple anecdotal stories of guys that tried once per week injections and as frequent as EOD, and noticed no difference to their SHBG. Not saying your wrong, just curious.

Since this has been narrowed down to thyroid, remember that taking larger doses of T3 to reduce your RT3 is only a temporary fix anyways (aside of what it does to your shbg), as soon as you stop the T3 your RT3 increases again. You have to fix the underlying problem first which is usually low ferritin or low cortisol unless you are sick. Would be nice to know your ferritin, and ideally 4 x saliva cortisol. You need to be sure of this info and most do not get a saliva test. TSH is 2.09, so it's suspicious, antibodies labs will help. Your FT4 is great, a little more T3 could be beneficial if nothing else is found. You can always try it and stop if it doesn't help.

If me, I would address any thyroid issue first. If SHBG does increase you can offset that with changing your protocol with less frequent injections with high doses of testosterone. If the thyroid is what is causing you to feel the way you do wouldn't you want to fix that?

MarkM said:

If me, I would address any thyroid issue first. If SHBG does increase you can offset that with changing your protocol with less frequent injections with high doses of testosterone. If the thyroid is what is causing you to feel the way you do wouldn't you want to fix that?

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MarkM, definitely. I'm not opposed to fixing either-or. Seeing how treating the thyroid affects SHBG makes sense. I'm sure my veins will hate the next few months from all the blood draws

Systemlord said:

Sure it's a double edge sword, but the proper course of action is to throw more androgens to manipulate it, larger injections (excess androgen activity) will lower SHBG and at the same time more Free T3 will speed up every cell in your body. A TRT protocol for a high SHBG guys is 1-2 large injections a week, whereas a TRT protocol for a low SHBG guy is small micro injections multiple times a week so you don't hammer SHBG that is already low.

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That makes sense, I suppose. Two problems, two solutions.

At some point, I'll need to find a doc to get an actual rx. Finding a doc that will help set/rx a protocol has proven ... tricky though.

ratbag said:

Since this has been narrowed down to thyroid, remember that taking larger doses of T3 to reduce your RT3 is only a temporary fix anyways (aside of what it does to your shbg), as soon as you stop the T3 your RT3 increases again. You have to fix the underlying problem first which is usually low ferritin or low cortisol unless you are sick. Would be nice to know your ferritin, and ideally 4 x saliva cortisol. You need to be sure of this info and most do not get a saliva test. TSH is 2.09, so it's suspicious, antibodies labs will help. Your FT4 is great, a little more T3 could be beneficial if nothing else is found. You can always try it and stop if it doesn't help.

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Just got the blood work back and will post up the results shortly. You mention that a little more T3 could be beneficial if nothing else if found. Out of curiosity, why is that? Also, totally hear you that the underlying issues need to be fixed first.

The new blood work results are in. Let me know what y'all think.

Iron, Total: 89 mcg/dL (50-195)
Ferritin: 41 ng/mL (20-345)
Thyroglobulin Antibodies: <1 IU/mL (< OR = 1)
Thyroid Peroxidase Antibodies: <1 IU/mL (<9)


Albumin: 4.6 g/dL (3.6-5.1)
Globulin: 2.8 g/dL calc (1.9-3.7)
Albubin/Globulin Ratio calc: 1.6 (1.0-2.5)
Alkaline Phosphatase: 63 U/L (40-115)
ALT: 23 U/L (9-46)
AST: 17 U/L (10-40)
Bilirubin, Total: 1.3 mg/dL (0.2-1.2)
Protein, Total: 7.4 g/dL (6.1-8.1)
**test done after fasting for a little over 12 hours

I also had labs done for general lipids, kidney function, and electrolytes. Nothing out of range or eye raising, but it would help I'll post them up ASAP.

Side note: not sure how much inflammation would impact the bilirubin value, but I didn't sleep at all the night before the test (babysitting sister's infant kid, didn't fall asleep due to nerves/fear).

This is the only video that explains why more T3 can be beneficial. This is the underlying premise behind dosing thyroid properly. Sometimes your FT3 can look really good on paper and yet more T3 can make that person feel better. Reading Broda Barnes is the same thought process. This is how Thyroid was treated until the TSH test came out in 1973. Keep in mind the only reason the TSH test is so popular is that it's cheap for hospital admin and it's a clear line... meaning if your in range there is nothing wrong with you. Which we all know is wrong but it fits the administrations need to keep costs in check. There are millions of people with thyroid problems that have a normal TSH.

https://www.youtube.com/watch?v=XEB_rGOWsGU

ratbag said:

This is the only video that explains why more T3 can be beneficial. This is the underlying premise behind dosing thyroid properly. Sometimes your FT3 can look really good on paper and yet more T3 can make that person feel better. Reading Broda Barnes is the same thought process. This is how Thyroid was treated until the TSH test came out in 1973. Keep in mind the only reason the TSH test is so popular is that it's cheap for hospital admin and it's a clear line... meaning if your in range there is nothing wrong with you. Which we all know is wrong but it fits the administrations need to keep costs in check. There are millions of people with thyroid problems that have a normal TSH.

https://www.youtube.com/watch?v=XEB_rGOWsGU

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Interesting stuff. T3 is definitely on the lists of things I'll be bring up.

On my recent labs, it looks like my ferritin is on the low side of the range. From what I've gathered, this is a sign that I've got low iron and my body is going through its iron stores. Would this explain (even partially) the elevated reverse T3 range?

Yes it would explain a higher RT3. However low ferritin is quite common for TRT people. Many actually have high iron serum with low ferritin. Nonetheless you need decent levels of ferritin for both Thyroid and TRT to work properly.

ratbag said:

Yes it would explain a higher RT3. However low ferritin is quite common for TRT people. Many actually have high iron serum with low ferritin. Nonetheless you need decent levels of ferritin for both Thyroid and TRT to work properly.

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Did you mean trt people as though who are likely candidates or those on trt currently. I’m not actually on trt, yet. The high sbgh is making me believe that I may need to be.

I meant people who are on TRT. So you have low iron serum and low ferritin. Not below range but low in range. You need to work at that to get those numbers a little higher. I would suggest you start taking 25mg daily for a for 8 weeks and then retest your iron serum and ferritin.

ratbag said:

I meant people who are on TRT. So you have low iron serum and low ferritin. Not below range but low in range. You need to work at that to get those numbers a little higher. I would suggest you start taking 25mg daily for a for 8 weeks and then retest your iron serum and ferritin.

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Got it! I’ve started the taking iron and I’ll retest in roughly 8 weeks. Really appreciate the help!

Is there any explanation on why my SHBG levels are so high or why they’ve increased to the point that they have? I’ve tried looking online but I can’t find any solid reasons. Also, I haven’t been able to find anything concrete on how to lower SHBG levels (well, other than testosterone injection. There was some info on boron but there was a lot of doubt with it).

There aren’t really any environmental toxins, I don’t drink or take drugs (other than rx Adderall), I don’t have high estrogen, if the high RT3 can be explained by the low iron then I don’t have a thyroid issue, I eat a fairly clean and balanced diet, I’m not overtraining or killing myself with work stress.

Uniquerabbit said:

Is there any explanation on why my SHBG levels are so high or why they’ve increased to the point that they have? I’ve tried looking online but I can’t find any solid reasons. Also, I haven’t been able to find anything concrete on how to lower SHBG levels (well, other than testosterone injection. There was some info on boron but there was a lot of doubt with it).....................

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It could be that you naturally have high SHBG, as some naturally have low SHBG. Probably the best way to address your high SHBG is with your testosterone injection protocol. Taking larger injections once, maybe twice a week, will lower SHBG and increase your Free T. Your Free T has room to move up without being too high.

MarkM said:

It could be that you naturally have high SHBG, as some naturally have low SHBG. Probably the best way to address your high SHBG is with your testosterone injection protocol. Taking larger injections once, maybe twice a week, will lower SHBG and increase your Free T. Your Free T has room to move up without being too high.

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So that’s the thing, I’m not on TRT. Am I just stuck otherwise?