First TRT Lab Work - Looking for Advice

[Vtail]

Hello Gents – I’m 55yrs old (6ft, 195 lbs, generally good health and fitness) and started TRT about 2 months ago. Before starting my TT was 439 [264-916] and FT was 7 [7.2-24]. Doc started me on T-cyp (nothing else) at 100mg/week. I decided to split the dose at 50mg every 3.5 days. My main concern for starting TRT was cognition, and at about week 3 for about 1 week I felt great - higher energy, sharper focus, elevated mood. Now I'm back to about where I started, maybe marginally better. Below are my labs from pre TRT and just last week (drawn the morning of the day I inject – before the injection). I would consider myself ‘dialed in’ if I could get back to how I was feeling during week 3. Any advice on how I should proceed from here would be greatly appreciated. I have my follow-up appt with the doc later this week, and with input from this group my hope is to be able to have an educated discussion with him rather than just obediently listen and take notes. Thanks in advance!

 

[S1W]

I would discuss increasing your dosage with your doctor. Otherwise, continue with E3.5D and testosterone only for now.

 

[Systemlord]

You've likely got some degree of hypothyroidism and TRT will not work well when there are low thyroid hormones (Free T3/or high Reverse T3) indicated by elevated TSH. 95% of the population without any health issues score a TSH <2.5, those above are outliers with thyroid dysfunction.

This may be why you feel little better than you did pre-TRT. Your estrogen level may also be a factor in the way you feel, some guys are sensitive to estrogen and do feel better in the mid 20's. Estrogen levels that are too high for you can cancel out some of the positive mental benefits of TRT.

Lowering estrogen while keeping testosterone sufficiently elevated is easy, increase injection frequencies, smaller more frequent doses will keep testosterone elevated while lowering estrogen. No anti estrogen drugs needed.


I would look a little more closely at your thyroid by at least ordering a thyroid panel checking Free T3, Free T4, Reverse T3 and antibodies to see why TSH is elevated. Do not accept normal simply because you were in the normal range, these normal TSH ranges are invalid because previously some in the group that made up these ranges later found out to have thyroid dysfunction.

Those with thyroid dysfunction that made up the current ranges had a TSH >2.5.

 

[Vtail]

You've likely got some degree of hypothyroidism and TRT will not work well when there are low thyroid hormones (Free T3/or high Reverse T3) indicated by elevated TSH. 95% of the population without any health issues score a TSH <2.5, those above are outliers with thyroid dysfunction.

This may be why you feel little better than you did pre-TRT. Your estrogen level may also be a factor in the way you feel, some guys are sensitive to estrogen and do feel better in the mid 20's. Estrogen levels that are too high for you can cancel out some of the positive mental benefits of TRT.

Lowering estrogen while keeping testosterone sufficiently elevated is easy, increase injection frequencies, smaller more frequent doses will keep testosterone elevated while lowering estrogen. No anti estrogen drugs needed.


I would look a little more closely at your thyroid by at least ordering a thyroid panel checking Free T3, Free T4, Reverse T3 and antibodies to see why TSH is elevated. Do not accept normal simply because you were in the normal range, these normal TSH ranges are invalid because previously some in the group that made up these ranges later found out to have thyroid dysfunction.

Those with thyroid dysfunction that made up the current ranges had a TSH >2.5.

That's very helpful - thank you. I have a follow-up with my doc tomorrow. If he seems uninterested in exploring any possible Thyroid issues, I may have to re-evaluate where I go for treatment. He's a urologist with seemingly good experience in TRT, but he didn't mention the TSH value being on the high side. I also have elevated glucose and potassium (both slightly out of range), and after googling this a bit it seems that a sluggish Thyroid can be responsible for that as well. All this was in the blood test reviewed by my Doc prior to starting TRT.

Maybe I'm expecting too much from my Doc, but this brings to mind another sort-of-related question. If I was under the care of DEFY, is this Thyroid issue the sort of thing they would typically pick up on and investigate further, or would I have to bring it to their attention as I'm doing with my current doc? And is DEFY able to prescribe treatment for a Thyroid condition, or would I have to go to a specialist anyway? I went with a local doc because I was uncomfortable with the whole telemedicine thing (I'm in NY), but as I gain some knowledge about TRT, and with the resources on this board, I'm getting more comfortable with the idea.

 

[CoastWatcher]

Defy Medical treats patients with thyroid issues. It's part of their standard workup for all patients. It should be one all doctors incorporate in their initial lab work.

Good luck.

 

[salvageman]

You've likely got some degree of hypothyroidism and TRT will not work well when there are low thyroid hormones (Free T3/or high Reverse T3) indicated by elevated TSH. 95% of the population without any health issues score a TSH <2.5, those above are outliers with thyroid dysfunction.

This may be why you feel little better than you did pre-TRT. Your estrogen level may also be a factor in the way you feel, some guys are sensitive to estrogen and do feel better in the mid 20's. Estrogen levels that are too high for you can cancel out some of the positive mental benefits of TRT.

Lowering estrogen while keeping testosterone sufficiently elevated is easy, increase injection frequencies, smaller more frequent doses will keep testosterone elevated while lowering estrogen. No anti estrogen drugs needed.


I would look a little more closely at your thyroid by at least ordering a thyroid panel checking Free T3, Free T4, Reverse T3 and antibodies to see why TSH is elevated. Do not accept normal simply because you were in the normal range, these normal TSH ranges are invalid because previously some in the group that made up these ranges later found out to have thyroid dysfunction.

Those with thyroid dysfunction that made up the current ranges had a TSH >2.5.

My recent thyroid labs are below, would you be concerned with hypothyroidism with these results??
thyroglobulin ab <10 range 10-115 iu/ml
hsbg 54 range 10-80 nmoles/l
tsh 3.26 range .30-5.00 mciu/ml
t4 free 1.32 range .80-1.80 ng/dl
t3 free 3.2 range 2.0-4.4 pg/ml
wasn't tested for reverse t3
Curious about your thoughts!

 

[Systemlord]

No Reverse T3 testing in the presence of elevate TSH, that's a problem because Reverse T3 blocks Free T3 at the receptors and disables some or most of that Free T3 and could explain elevated TSH.

 

[salvageman]

No Reverse T3 testing in the presence of elevate TSH, that's a problem because Reverse T3 blocks Free T3 at the receptors and disables some or most of that Free T3 and could explain elevated TSH.

Thank you!