Not feeling better on TRT + Thyroid problems

I've been having problems with severe fatigue, insomnia (waking in the middle of the night, not feeling rested) and mental fog in the last 2 years or so. Last year around this time my total T was measured to be in the 200s. Finally I went on TRT from last November. My current regimen is:

Tuesdays: T Cyp 40mg, HCG 400 IU
Friday T Cyp 50 mg, HCG 400 IU

I was started on a much higher dose of T though. All my problems still persist and they may have got even worse. Here are some lab results from a couple weeks ago:

Estradiol: 33.7 in 8-35
Progesterone: 0.2 in 0-0.5
Total T: 867 in 264-916
Free T: 29.4 in 8.7-25.1
Prolactin: 7 in 4-15.2
DHEA-S: 341 in 102.6-416.3


fT3: 3.8 in 2-4.4
fT4: 0.86 in 0.76-1.46
rT3: 18.9 in 9.2-24.1
TSH: 0.985 in 0.385-3.74

I'm also deficient in both iodine and Vitamin D. I started taking iodine and more vitamin D after I got the results.
My main concern is with estradiol. My T/E ratio has actually decreased since I went on TRT. I've read that high E2 causes problems like hypothyroidism, fatigue and insomnia, all of which I have. I started taking 0.5mg/week of arimidex but seems it makes me more fatigues. (This is ones of its common side effects actually.)

Also what is the actual cause of my hypothyroidism? High E and low iodine or something else? My doc put me on dessicated thyroid and it seemed to work but I stopped because I wanted to find the actual cause. I'm going to meet him in a week.

More about me: in late 30s, lean, don't eat crap, drink a coffee in the morning and I work out quite a bit.

Welcome,

I see the problem, you protocol is whackly, 40mg one day and 50mg the next which means you will never reach a stable state because you dosage is always changing. When starting TRT you must keep the dosage the same, any small changes prevents you from reaching a stable state 6 weeks after either starting TRT or changing the dosage at a later date. No SHBG labs, it's used by knowledgeable doctors to design a protocol. SHBG tells us how well you hold on to your testosterone. Your doctor has sabotoshed you.

Thyroid looks good.

It's clear this doctor doesn't know how to play the TRT game.

The only concerned about your thyroid is your higher level of reverse T3, are you in a thyroid meds?

Getting a good night's sleep would really help, do you use or you should consider using melatonin.

Forgot to mention I'm concerned about alcohol too. When my low T and poor sleep was worst, I was drinking a shot almost everyday. I've reduced it to a drink per week but am thinking I may better stop it completely.

I was actually started on 2x70mg of T per weak and then my TT and E2 went through the roof. Reduced to 2x50 in January and then I myself reduced to this "whackly" one in April. The reason I didn't go for 2x45 is 1-difficult to dose with 200mg/ml T and 2-unequal number of days between the injections.

My doc is actually a very famous one! SHBG is 36.1 in 16.5-55.9.

Agree with Vince your Reverse T3 is still high which may be contributing to your problems. It needs to be less than 15 and here is a good explanation of how to lower it. You may want to ask your Dr. to add a dose of T3 med to your NDT to help lower it.

https://www.restartmed.com/reverse-t3/

I know since my RT3 was 28.1 back in Feb before starting Cytomel and I felt awful but, 2 months later and it was down to 13.1 and felt much much better.

Alive said:

Forgot to mention I'm concerned about alcohol too. When my low T and poor sleep was worst, I was drinking a shot almost everyday. I've reduced it to a drink per week but am thinking I may better stop it completely.

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Doubt that's your problem. Not advocating drinking more alcohol, or any at all if you don't wish to, but less than two drinks per day in men is considered moderate use and the literature suggests physiological effects at and below that level are benign to beneficial. One drink a week is less than 7% of that.

Your FT4 is less than 50%. It should be in the top third of range. This means it should be above 66%. This will help reduce or possibly eliminate your hypothyroidism. Your deficiencies need to be addressed because we have seen members improve their symptoms dramatically by getting normal levels of Vit D.

ratbag said:

Your FT4 is less than 50%. It should be in the top third of range. This means it should be above 66%. This will help reduce or possibly eliminate your hypothyroidism. Your deficiencies need to be addressed because we have seen members improve their symptoms dramatically by getting normal levels of Vit D.

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What is a good way to get enough D (apart from sunlight LOL)? Before the test I was taking a tbs of cod liver oil (800 IUs of D) and a couple of raw eggs a day but even with those my Vit D-25 HIDROX was 25.8 in a 30.0-100 range. In the past I got fatigue as a side effect of high doses (5000 IUs) of D.


On a different note Arimidex is not good for me. I feel so fatigued and my breath is short (it can reduce your red blood cell count). I won't take it anymore but am still concerned about my high E2. My clinic is Defy which does not like AIs.

You need to start taking T4, Talk to your MD a Defy. Perhaps you could try a dose in between like 2000iu Vit D3?

Oh noooo. we can't edit our posts.

You appear to be pooling ...
FT3 is at 75% of reference range
FT4 is at 14% of reference range
FT3/RT3 ratio is slightly over 20, "BUT" I don't think there is all that much T4 being produced, as TSH is < 1.0. If more demand was put on producing T4, I think the RT3 would be even higher.

I would also like to see your antibodies (TPO and TgAb)?

D3 and iodine are great places to start, selenium also needs to be in the discussion, especially if TPO is an issue (?)

Pooling is usually problematic with iron & ferritin, and also cortisol imbalance. Those should be the primary areas of focus, and most areas of metabolic/electrolyte & CBC's should be included in this discussion.

What is pooling? I didn't do TPO and TgAb, just ANA and CPR which were OK. Will post my electrolyte panel and CBC shortly.

Cortisol test was done in the morning.

That doesn't look like a 4 x diurnal salivary test. I only see 1 result. is that morning? There should be 4 values, one each for Morning, Noon, Evening and Bedtime. You need all 4 times. Without it you don't know what stage your adrenal insufficiency is in. Assuming that result is the morning cortisol you are definitely quite low. The morning salivary cortisol should be the highest of the day. As you can see you are no where near that. Unfortunately you need to get this for all 4 periods of the day.

Yeah only in the morning. Some of these tests, including cortisol, I asked the clinic to add and the staff just jotted them on the prescription.
So you say this is adrenal insufficiency? So low T, hypothyroidism, and adrenal insufficiency. What's behind all of these? I also have a genetic disorder because of which my red blood cells are smaller than usual, as you can see in my CBC.

Alive said:

Cortisol test was done in the morning.

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You stated in an earlier post:

"On a different note Arimidex is not good for me. I feel so fatigued and my breath is short (it can reduce your red blood cell count). I won't take it anymore but am still concerned about my high E2. My clinic is Defy which does not like AIs."

Your most recent labs your RBC/RDW are high but your MCV/MCH are low and your hemoglobin/hematocrit are in the lower end.....iron deficieny?

You did not have your ferritin/iron tested as they are critical to know especially in relation to thyroid function.

Yes, I had ferritin tested:



Here is iron FROM 3 MONTHS AGO:




To be clear I took Arimidex for just 10 days AFTER the tests. I have a disorder called thalassemia minor which is the cause of the unusual CBC.