Feedback on test results on TRT: Patient on TRT, Thyroid Rx, and Adrenal Support

alsi33 · 2026-10-24T10:21:41-0500

I have been on TRT since August 5, 2026. I take 150 mg (0.75 ml) of Testosterone 20% Gel in am. I am looking for some feedback regarding my test results and if I should address Iron deficiency based on low Ferritin which went down significantly on TRT. I have a TRT doctor’s consult next week to discuss.

Just to give you a complete picture, I have SAI, hypothyroidism, and hypogonadism, all diagnosed by doctors. I am 53 yo, weight is 215, height 180 cm (5.9 foot). My normal weight was 160 lb but I have gained a lot since starting HC for SAI 15 years ago.

Below are my test results done in Canada, the units are different from US. Tests were done in October 2026.

Current Medication Regimen:

TRT: Testosterone Gel applied daily in AM
Adrenal: Hydrocortisone (HC) daily split across multiple doses (4 per day). Total: 27.5 mg.
Thyroid: Natural Desiccated Thyroid (NDT) daily split into morning and afternoon doses. Total: 135 mg (2.25 grains)
Pregnenolone daily split across multiple doses (4 per day). Total: 200 mg (I take it to help me with hypoglycemia symptoms; I can not tolerate thyroid without it)

Breakdown of Results

Total Testosterone: 17.86 nmol/L (2.80–21.60)
Bioavailable Testosterone: 12.44 nmol/L (3.60–11.30)
Free Test (calculated myself): 0.0679 ng/dL = 0.38 % (per calculator on www.issam.ch/freetesto
Sex Hormone-Binding Globulin (SHBG): 16.9 nmol/L (13.3–88.5)
Albumin 47 G/L (38-52)
Estradiol: 159.0 pmol/L (70- 150)
LH: less than 0.2 (2.5-16)

TSH: 2.84 mIU/L (Normal: 0.40–4.40)

Free T3: 4.92 pmol/L (Normal: 3.80–6.00)

Free T4: 8.00 pmol/L (Normal: 8.00–18.00)

Insulin 280 (13-161) pmol/l

DHEA 0.8 umol/l (0.1-5)

Cortisol 268 nmol/L (120-535)

Ferritin: 19.5 ug/L (Normal: 23.9–366.0)

Iron 22.8 umol/l (10.6-23.8)

Iron Saturation 0.27 (0.26-0.42)

Transferrin 3.37 g/L (2-3.70)

Hemoglobin: 150 g/L (Normal: 135–175)

Hematocrit: 0.469 L/L (Normal: 0.420–0.520)

I had to stop DHEA supplementation in order to tolerate TRT. When on both in the past, my libido was decreased a lot and I had very weak erection likely due to too much Estradiol. However, when I stopped DHEA, which kept my insulin down, my insulin shot up from 70 to 280 which is very concerning to me and I gained more weight. This severe hyperinsulinemia locks my body in fat-storage mode.
In general, on TRT, I feel a bit better, have improved insulin sensitivity but still very much work in progress. I need to work on increasing thyroid replacement dose as I am not optimized on Thyroid. Even though my cortisol is not bad on the test, I am not able to decrease HC medication and I tried many times to do that.

Thank you very much for your feedback.

Nelson Vergel · 2026-10-24T10:33:32-0500

Thanks for the detailed post. Some points to bring to your doctor next week:

1. Your free T calculation is off. With TT 17.86, SHBG 16.9 and albumin 47, the Vermeulen formula gives free T of about 0.48 nmol/L (≈140 pg/mL, 2.7%). That matches your lab’s bioavailable T of 12.4 almost exactly. Your free T is upper-normal. Your dose is doing its job. Don’t raise it.

2. Estradiol 159 pmol/L (43 pg/mL) is mild and common on gel, especially with low SHBG and extra body fat. I would not add an AI based on this number. Treat symptoms, not the lab value. Crashing E2 hurts libido, erections and bone. Your past problem happened on TRT plus DHEA, so it may not repeat now.

3. Ferritin 19.5 is iron deficiency. Saturation at 27% is borderline. TRT lowers hepcidin and pulls iron into red cell production, so ferritin often drops in the first months. Before supplementing:

Rule out blood loss. At 53, a FIT test or colonoscopy is reasonable. Hydrocortisone can irritate the GI tract.
Screen for celiac (tTG-IgA). It also impairs thyroid and iron absorption.
Tell your doctor if you donate blood.

If cleared, oral iron every other day absorbs better than daily. Take it at least 4 hours away from NDT, since iron blocks thyroid absorption. Recheck ferritin and hematocrit in 8 to 12 weeks. Hct (0.469) will rise as iron refills, so watch it.

Low iron also worsens hypothyroid symptoms and can affect how well you tolerate thyroid dose increases. Fix it alongside the thyroid work.

4. Thyroid is under-replaced. TSH 2.84 with free T4 at the floor and FT3 mid-range on 135 mg NDT supports a slow increase. Your adrenals are covered by HC, so raising thyroid is safe from that angle. Draw labs before your morning NDT dose so FT3 isn’t a peak reading.

5. The insulin is the biggest issue. 280 pmol/L is roughly 40 to 47 µIU/mL. Confirm it was fasting and add fasting glucose, HbA1c and HOMA-IR. The likeliest driver is not DHEA. It’s 15 years of hydrocortisone. Guidelines put replacement at 15 to 25 mg/day, and you’re at 27.5. Late-day doses especially raise insulin and drive central fat gain. Ask your endocrinologist to review dose timing and total, even if tapering has failed before. Slow reductions of 1 to 2.5 mg with a review of your stress dosing plan work better than larger cuts.

DHEA data on insulin sensitivity is weak and mixed. If you want to retry it, use a low dose (10 to 25 mg) and recheck E2.

6. Ask about metabolic medication. Metformin or a GLP-1 (semaglutide or tirzepatide) can lower insulin and weight. With adrenal insufficiency, GI side effects like vomiting can trigger an adrenal crisis, so your doctor needs a sick-day plan with you before starting. Pair any of these with resistance training and high protein to protect muscle.

7. Suppressed LH is expected on TRT. If testicular size or fertility matters to you, hCG is an option, but it raises E2, so time it after your other numbers settle.

Labs to add next round: fasting glucose, HbA1c, lipids, PSA, CMP, ferritin panel, and note the hours since gel and NDT.