Finally Got my Full Panel...Way Low Testosterone

[John O'Connor]

Chris his latest blood work was from 3/1/16, and he was put on 50mcg Synthroid after that. As of post #14 on this thread (4/8/16) he states he has been taking it for 3 weeks. So at this point he has taken it for a total of 4 weeks.

NSM - here is a good (long) explanation of why its preferred that you wait until after your blood draw to take your Synthroid. Either way its not a big deal, with Synthroid (aka T4) but the preference is to not take it just before the blood is drawn. Synthroid is simply T4, other versions of thyroid medicine have both T4 and T3 (the more active form of thyroid hormone). The article explains everything in detail, but essentially the highlights are below:

http://drcherylkasdorf.com/2015/08/10/meds-before-test/

"[h=2]The Bottom Line In most cases, more accurate tests result when the thyroid hormone medication is taken after the thyroid test, not before."[/b]"It seems the best is getting your thyroid function tests done first thing in the morning, bringing your medications with you, and taking them right after you have your thyroid function tests to ensure that you get accurate test results."

 

[Vettester Chris]

John, thanks for clarifying the dosage. Wow, it's only 50mcg, which is barely equal to 1/2 grain when comparing to NDT. I just can't imagine any doctor really believes that's a good protocol (?), but then again none of this is too shocking anymore!!

Agree totally with how to go about the labs ... Keep us posted NSM!

 

[John O'Connor]

John, thanks for clarifying the dosage. Wow, it's only 50mcg, which is barely equal to 1/2 grain when comparing to NDT. I just can't imagine any doctor really believes that's a good protocol (?), but then again none of this is too shocking anymore!!

Agree totally with how to go about the labs ... Keep us posted NSM!

Chris - Only 50mcg??? Are you confusing the typical Synthroid/levothyroxine dose based in mcg (micrograms) with that of a typical NDT (dessicated thyroid), which is measured in mg (milligrams)?
I don't have a great source for this, but this is the conversion I found online:
1 grain (60 mg) of Armour thyroid contains 9 mcg of T3 and 38 mcg of T4.

I just want to clarify - 50mcg is a common dose for Synthroid (generic = Levothyroxine) for individuals with moderately elevated TSH in the 3.0-5.0 range. Many individuals take just 25mcg or 37.5mcg.

I was originally diagnosed with Hashimoto's thyroiditis with TSH of 3.8, and Anti-TPO of 800 (0-50). I was put on 50mcg, and it lowered my TSH to a range of 0.80 -1.20 consistently.

After 1 year on levothyroxine my TSH jumped to the 1.5-1.8 range, and my dose was increased to 75mcg. After a couple months at this higher dose my TSH dropped too low (to 0.60) and my doctor immediately switched me back to the 50mcg dose.

These changes were a learning experience. When I initially began taking levothyroxine (2006) I took it 1st thing in the morning on an empty stomach and did not eat for 1 full hour after taking it.
As time went on, I stopped fasting for the full hour. Some days i waited 45 minutes to eat while other days I might only wait 30 minutes. This caused me to need the higher 75mcg dose, as eating sooner was impairing the absorption rate of the medication. But when I began taking it regulary with a full 1 hour before food - the 75mcg dose was too much - thus the low 0.60 TSH measurement.

Note I'm 6-0 tall, and weigh 180. So a lower dose works well for me as someone with only mild thyroid function impairment (TSH 3.8 without meds).

Someone like NSM, who is 6-0, but weighs 300 lbs, may need an equal or higher dose to produce a similar effect, despite having a less significant impairment of thyroid function (TSH 2.7).

Here is a link to a study showing correlation between dosage and body mass index. Note these patients had their entire thyroid removed due to thyroid cancer (total thyroidectomy) - so they have 100% impairment, as opposed to NSM and myself who only have mild impairment of our thyroid function. So it is logical that they would need much higher doses, likely 2x to 3x higher than our 50mcg doses.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658157/
"The conventional method of thyroid replacement therapy involved an empiric dose of 100-150 micrograms per day. Following this regimen, between 21-37% of patients attained a euthyroid state at initial follow up."

Euthyroid definition = the state of having normal thyroid function (or normal Thyroid hormone levels as a result of thyroid hormone replacement via medication (synthroid, levothyroxine, etc.)

Note - we are all learning here - and I do not have all the answers, I was just concerned that some people reading Chris's comment "Wow, its only 50mcg" might interpret that incorrectly.

Please correct me if I misunderstood anything. All the best, John

 

[Vettester Chris]

John, here is a conversion chart that will crossover almost every synthetic TM to NDT's (Armour & Westhroid to be exact). So when everything settles out, converts T4, T3, T2 & T1, this is roughly going to be the results. 50mcg or 1/2 grain is an introduction protocol at best, then should be titrated thereafter to reach optimal well being, based on labs, body temperature analysis, and feedback with how the patient feels.

Not to hijack this thread, but usually the route to treat Hashi's with thyroid meds is to titrate to dosages that will actually stop the attacks. 1/2 grain, 1 grain "usually just feed the fire for for repeat episodes. However, TPO enzyme attacks can sometimes be controlled with lower dosages and selenium combined. Anyhow, I don't have Hashi's, but have dealt with many over the years that have. Most that took synthetics didn't do well at any dosage, and on NDT's they were "usually" up to 3 grains or more to mitigate the attacks. Everyone is different, so if 50mcg of T4 does it for you all the power!!

 

[Dr Justin Saya MD]

Chris is correct with his explanation taking into account the BIOLOGICAL STRENGTH/POTENCY of the NDTs (T1, T2, T3, T4) although this is a common area of confusion even for physicians treating thyroid patients (I see it all of the time in patients coming over on thyroid treatment from other providers).

John is also correct, on the surface, that 1 grain of NDT *contains* approximately 9mcg of T3 and approx 38mcg of T4....HOWEVER we must not equate *contains* with *equivalent to* when it comes to dosage conversions as we have to factor in the biological potency/strength into our thought process.

The general belief on the pharmacological side is that T3 is approx 3-5x more "potent/stronger" when it comes to dosing and "biological effect" than comparable T4. Through my experience, I would lean more towards the 5x side or even slightly better. Thus, with a 1 grain NDT:

Contains approx 9mcg of T3 (~ equivalent to 9x5 = 45mcg T4)
Contains approx 38mcg of actual T4

45mcg + 38mcg = 83mcg ...BUT we also must take into account T1/T2 however these are trace amounts for the most part as these are primarily created OUTSIDE of the thyroid via deiodination...even with trace amounts, however, we must consider they carry some biological potency. Thus, I typically consider 1 grain of NDT roughly equivalent in biological effect to ~90mcg of T4 (1/2 grain ~45mcg of T4). Hope this makes sense!

 

[GA8314]

My GGT numbers are probably high because of the alcohol binge I had been on.

Ask yourself this. Is alcohol SERVING me?? Are the benefits you get from alcohol worth the drawbacks to your health? Hangovers in the a.m.? I'm guessing if you are over consuming alcohol then the answer is no, it's not serving you.

Try NO ALCOHOL for 30 days and see how you like it. Is that lifestyle better serving you? Let us know.

 

[NOSUPERMODEL]

I'm not saying you are wrong, and I agree it would be nice to know Reverse T3 - but for argument sake and my overall understanding - With Total T4 & T3 low, isn't it impressive that free T3 is mid-range? I think his body may be optimizing his low total levels to produce the active form (Free T3). Also since he is now on 50mcg Synthroid - future tests may not tell complete picture - as you would expect all of the numbers to increase and TSH to decrease. I really think his doctor jumped the gun by prescribing Synthroid without further tests to confirm what is going on.
T4 = 6.6 (4.5 - 11.7)
T3 = 1.2 (0.8 - 2.0)
Free T4 = 1.1 (0.9 - 1.7)
Free T3 = 3.3 (2.0 - 4.4)

Note Vitamin D is 25 (30-100), and anti-TPO is 8 (<34)
I wonder what these numbers would look like if he got Vitamin D to 50+. Again assuming he was not taking Synthroid, as that is hiding any improvements Vitamin D may be providing.

Nosupermodel - how many IUs of D3 are you supplementing now and when did you start? Any idea when you will recheck your Vitamin D levels?

I am taking 2000iu. I started 4 weeks ago. I will check it again on April 25tg

 

[NOSUPERMODEL]

I'm not saying you are wrong, and I agree it would be nice to know Reverse T3 - but for argument sake and my overall understanding - With Total T4 & T3 low, isn't it impressive that free T3 is mid-range? I think his body may be optimizing his low total levels to produce the active form (Free T3). Also since he is now on 50mcg Synthroid - future tests may not tell complete picture - as you would expect all of the numbers to increase and TSH to decrease. I really think his doctor jumped the gun by prescribing Synthroid without further tests to confirm what is going on.
T4 = 6.6 (4.5 - 11.7)
T3 = 1.2 (0.8 - 2.0)
Free T4 = 1.1 (0.9 - 1.7)
Free T3 = 3.3 (2.0 - 4.4)

Note Vitamin D is 25 (30-100), and anti-TPO is 8 (<34)
I wonder what these numbers would look like if he got Vitamin D to 50+. Again assuming he was not taking Synthroid, as that is hiding any improvements Vitamin D may be providing.

Nosupermodel - how many IUs of D3 are you supplementing now and when did you start? Any idea when you will recheck your Vitamin D levels?

Ask yourself this. Is alcohol SERVING me?? Are the benefits you get from alcohol worth the drawbacks to your health? Hangovers in the a.m.? I'm guessing if you are over consuming alcohol then the answer is no, it's not serving you.

Try NO ALCOHOL for 30 days and see how you like it. Is that lifestyle better serving you? Let us know.

I am actually finishing up my second week of no alcohol. Yes I feel different. Better in a way. I was probably drinking a 6 pack a night Monday-Thursday and more than that on the weekends. Believe me when I say I can put some beer away. Never really have gotten hangovers in my life. Might be a little fright but nothing like they play it up on TV.

I'm trying to get healthier. Just completed my 5th week in the gym. Working with a trainer who does my nutrition and workouts. So I'm trying to get on the right track.

 

[NOSUPERMODEL]

This all has me confused as I am not medically smart. From what I understand my thyroid is not functioning at optimum level. Thus making it hard to lose weight and very easy to gain weight. Correct?

Once I get the thyroid working optimal should I be able to lose weight easier? I also do not do well with carbs. I thinks it's insulin sensitivity? I have to cut them completely out to really start to lose. Does thyroid have any effect on this?

I just want to be normal and have everything working optimally.

 

[CoastWatcher]

This all has me confused as I am not medically smart. From what I understand my thyroid is not functioning at optimum level. Thus making it hard to lose weight and very easy to gain weight. Correct?

Once I get the thyroid working optimal should I be able to lose weight easier? I also do not do well with carbs. I thinks it's insulin sensitivity? I have to cut them completely out to really start to lose. Does thyroid have any effect on this?

I just want to be normal and have everything working optimally.

You're right - there certainly seems to be an issue (or issues) with your thyroid. The so-called master gland, when the thyroid is not performing as it should the effects can be felt throughout the body. That includes the loss of weight. But if you have been regularly engaging in significant bouts of beer that, in and of itself, can work against weight loss. What were your last A1C readings?

You our are taking the right steps to square your health away. It may not happen as quickly as you'd like, but with the right doctor and some effort you should see results.

 

[Vettester Chris]

This all has me confused as I am not medically smart. From what I understand my thyroid is not functioning at optimum level. Thus making it hard to lose weight and very easy to gain weight. Correct?

Once I get the thyroid working optimal should I be able to lose weight easier? I also do not do well with carbs. I thinks it's insulin sensitivity? I have to cut them completely out to really start to lose. Does thyroid have any effect on this?

I just want to be normal and have everything working optimal.

NSM, you're doing great, and you've no doubt have learned a ton by just reading and corresponding on this forum. Don't get too overwhelmed with all the details. Like anything, it's just a learning curve, and just a little time and research will be knowledge that sticks with you for life!

We're kind-a adding to this confusion, because we are drawing a lot of speculation scenarios based on the labs we don't know about. Just take a deep breath, draw the labs that have been mentioned, then at least for discussion standpoint we will be able provide some comments.

And YES, on an optimal thyroid helping with weight. However, of course that is combined with a proper diet, exercise, sleep/rest, stress reduction, etc. On the carbs, I've always been a sucker for them (sugar too, but that's another story). For me, I shifted my intake so that most my carbs are earlier in the day. At night, more into the proteins, and fats + omegas just before bed. Nothing like some good natty peanut butter at bedtime.

 

[John O'Connor]

I am taking 2000iu. I started 4 weeks ago. I will check it again on April 25tg

NSM - Keep taking the 2000iu Vitamin D. I'm guessing you may need a higher dose, but the April 25th blood test will tell you more. Try to get 20 minutes of sun when possible in addition to your current supplementation.

Here is some additional info that you should also keep in mind. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h6

"Groups at Risk of Vitamin D Inadequacy: Older adults... People with limited sun exposure... People with dark skin... People with inflammatory bowel disease and other conditions causing fat malabsorption ... & People who are obese or who have undergone gastric bypass surgery - A body mass index &#8805;30 is associated with lower serum 25(OH)D levels compared with non-obese individuals; people who are obese may need larger than usual intakes of vitamin D to achieve 25(OH)D levels comparable to those of normal weight [1]. Obesity does not affect skin's capacity to synthesize vitamin D, but greater amounts of subcutaneous fat sequester more of the vitamin and alter its release into the circulation..."

 

[John O'Connor]

This all has me confused as I am not medically smart. From what I understand my thyroid is not functioning at optimum level. Thus making it hard to lose weight and very easy to gain weight. Correct?

Once I get the thyroid working optimal should I be able to lose weight easier? I also do not do well with carbs. I thinks it's insulin sensitivity? I have to cut them completely out to really start to lose. Does thyroid have any effect on this?

I just want to be normal and have everything working optimally.

NSM - focus on what you are learning, and the positive changes (gym, personal trainer, better nutrition, less alcohol). You are doing awesome - and don't be surprised that you are inspiring someone just reading your posts to start making similar changes in their own lives. We are all a "work-in-progress".

Your thyroid may not be functioning 100%, but its truly not very far off and I'm not sure it won't get to 100% on its own with all the positive changes you are currently making. Let the blood work results be your guide.

I'm looking forward to hearing about your progress over the months ahead. Have patience and keep doing what you are doing.

 

[NOSUPERMODEL]

Thanks guys. I will keep up the Vitamin D and get it retested. And just to make sure I have this correct, I would like to see if I can summarize what all I need to do on this blood draw on the 25th.

As of this morning(April 19th) I took my 30th pill of Synthroid. Should I stop taking it as of now, or continue its use and get tested on the 25th?

What are all the additional test I need to ask for. I know the Reverse T3 is one of them. I know I want my vitamin D tested again? DHEA? Sensitive on the Estrogen, correct?

If someone could just please summarize what I need to ask for additionaly on top of what was tested originally.

Also...my wife is going to go with me and get her blood drawn. Not necessarily to start any hormones, but that she wants to see what is going on with here body. Are there any specific test she should ask for?

 

[NOSUPERMODEL]

Here are the results from my blood work finally. Please let me know if any of this helps interpret anything. This is taking 200mg Test E per week broken up into two 100mg shots with 1mg of Arimidex per week also.

 

[CoastWatcher]

Here are the results from my blood work finally. Please let me know if any of this helps interpret anything. This is taking 200mg Test E per week broken up into two 100mg shots with 1mg of Arimidex per week also.

It would appear your doctor ordered the incorrect estradiol test - you wound up with the standard rather than the sensitive (LC, MS/MS) procedure. Given that the estradiol results are, at best, suggestive, it raises the question of whether you need to be on Arimidex at all. No RT3 was run? FT4 certainly came in low. You could supplement your Vitamin D. Your total testosterone looks reasonable. Have you discussed these results with your doctor?

 

[NOSUPERMODEL]

It would appear your doctor ordered the incorrect estradiol test - you wound up with the standard rather than the sensitive (LC, MS/MS) procedure. Given that the estradiol results are, at best, suggestive, it raises the question of whether you need to be on Arimidex at all. No RT3 was run? FT4 certainly came in low. You could supplement your Vitamin D. Your total testosterone looks reasonable. Have you discussed these results with your doctor?

I just received them yesterday. No I have not discussed them with my doctor. They missed a lot of labs. The sensitive Estrogen, The reverse T3. I asked for my Prolactin, Pregesterone and Cortisol to be checked also. I know they were on the lab request sheet because I saw it. But I don't know if the lab just didn't do them or what. I will be talking to him about that also.

What about my Thyroid. I was also on my Thyroid medicine they gave me at the time of this draw. Its 50mg Synthroid daily.

 

[John O'Connor]

The synthroid 50mcg dose you are currently on seems to be doing the job. It takes a while for levels to stabilize. Doctors normally recheck levels every few months when you first go on synthroid, then if labs look good after 9-12 months they will simply recheck annually. Reverse T3 would likely give a more complete picture - but you can wait until you get full labs again to recheck.

Vitamin D has gone up slightly from 25 on 3/1/16 to 33 on 5/9/16. Are you still taking 2,000 IUs daily? You should probably bump that up to 5,000 daily and recheck in a couple months. Try to get 20 minutes of sun each day too.

Your lipid panel looks improved - but the HDL (good cholesterol) is getting too low. Are you still losing weight? Have you cut lots of fats from your diet over the last few months? You still need good fats. Consider supplementing with a teaspoon of coconut oil a few times per day. It's supposed to increase the HDL. This video explains it: https://www.youtube.com/watch?v=IIOnLeriabA&feature=youtu.be

DHEA-S is in the low/normal range (pretty typical for most men age 30+), you may want to supplement with 50mg pregnenolone & 25mg DHEA daily to improve that number. The pregnenolone will also support cortisol production.

Your Total & Free T are slightly elevated. Was blood drawn on Day 8 trough? How often are you injecting?

It's concerning to not see a complete blood count while on TRT. You need to know your hematocrit/hemoglobin numbers when supplementing with TRT. Did you have a CBC done on 3/1/16 prior to starting TRT? It's not necessary, but would be helpful to know your baseline HCT/HGB numbers. You've only been on TRT since early March, so your levels are probably not too high. But you need to have them checked every 3 months and donate blood if they become elevated.

A tip for making sure all of the labs are ordered correctly - when you are at the lab for the blood draw - ask the person at check-in for a list of each test being done. Verify the estradiol sensitive version is the one they are pulling. If not, they might be able to change it right then. I did exactly that last month when I had my blood drawn - and the girl changed it for me on the spot - as my doctor choose the wrong one. It may not be intentional on your doctors part - ordering these labs can be confusing for them as their are so many options, but the people in the lab should be able to correct it, or make a quick call to your doctor to get the correct one ordered.

Also, give us an update on how you feel? Are you still working with nutritionist & personal trainer? Are you still losing weight? Any sexual issues? Morning wood pretty regular?

 

[NOSUPERMODEL]

I am still taking the Vitamin D. I have cut A LOT of fats. I try to get my fats now from natural PB, almonds, cashews, guacamole, etc... My bloods were drawn on a Monday morning. My protocol is 100mg on Monday and Thursday night. So it was about 3 1/2 days by the time blood was drawn. I don't know why a full CBC is not ordered. He used to order them. In fact, now that I think about it I think I ordered that to. What about my estrogen level even with being on 1mg Arimidex every Wednesday night? I'm still with the trainer. I'm down almost 20 pounds in 6 weeks. Morning wood was regular in the beginning, but it has gone away. So have the random erections. I was hoping the SHBG, Test, Estrogen and whatever else might explain something.
Thanks for looking into everything. Any other advice is appreciated. I will be headed out of town here shortly so I will randomly check in and reply if I see post. Otherwise see y'all Monday.

 

[John O'Connor]

You definitely need more Vitamin D.
Your lipid panel is suggesting you are not getting enough of those good fats. I'd definitely recommend trying the coconut oil per above.
This may seem extreme - but I'd recommend cutting your current cypionate dose in half, to 50mg E3.5D. Note - this advice is coming from someone currently taking 40mg E3.5D. I don't have updated bloodwork since switching to the E3.5D routine, but my doctor originally started me on 50mg weekly, then upped me to 80mg weekly - at which point I had the same symptoms you are currently describing. I went from morning wood 4-5 days per week, to only having it once per week, typically close to my trough day when my levels dropped. Now on this new regimen of 40mg E3.5D I have wood most mornings. Sometimes less is more.