Need TRT?

[Vonko1988]

Hello, Im new in this forum however I've spent a lot of time reading in other TRT forums, reading books about it, watching some of the leading doctors' podcasts and so on. I've had two consultations with Defy and am proceeding as their plan.

However, I want to ask the opinion of some of the knowledgeable users here: Do I need TRT?

My story: I'm 30 years old and I never had excellent health or physique. However my physical and mental well being declined notably in the last two years together with my libido, energy, mental clarity and basically showing all agreed low T symptoms. My total testosterone now is in the range of 400-500s, free T around 8-9 ng/dl calculated. I know its not terrible, but its not great either. I also have subclinical hypothyroidism and non-cancerous thyroid nodule. I experience hypo symptoms as well. Currently I'm on 12.5 mg T3 as advised by Defy due to high Reverse T3, Im also taking cabergoline since April due to slightly elevated prolactine(no tumor, but empty sella present).

The idea of Defy is to see if the T3 and the caber dose we recently increased can increase my testosterone a bit and possible start feeling better without TRT. My personal opinion is the likely hood of this is very small. The last summer I also lost 10kg with strict diet and exercise, Im now maybe around 18-20 percent body fat. The results in gym come very slowly and difficult for me. In order to loose weight I need to train really hard and sustain strict caloric count. Im on metformin for a few months now and it greatly helps me control nutrition. These are my last blood results:

TSHS 1.74 µIU/ml 0.27 - 4.20 ECLIA
Free Т4 (fT4) S 14.66 ng/ l9.30 - 17 ECLIA
Free T3 (fT3) S 2.79 ng/l 2 - 4.40 ECLIA
Reverse T3 S 232pg/ml 90 - 215 RIA
ТАТ (Tg Ат) S 10 IU/ml 0 - 115 ECLIA
A-TPO (MAT) S 5 IU/ml 0 - 34 ECLIA
Total Testosterone S18.06 nmol/l 9.90 - 27.80 ECLIA
SHBG S 43.97 nmol/l 18.30 - 54.10 ECLIA
LH S 4.54IU/L 1.70 - 8.60 ECLIA
FSH S 1.39IU/L 1.5 - 12.40 ECLIA
Prolactin S 265.4mIU/L 84.80 - 318ECLIA
Estradiol S 27.07ng/L 7.63 - 42.60 ECLIA
DHEA-s S 9.01 µmol/l 4.34 - 12.20 ECLIA
Cortisol (morning) S 363.6 nmol/l 133 - 537 ECLIA
Cortisol (afternoon) S 324.6 nmol/l 68.20 - 327 ECLIA

I have more blood values.

My plan is to wait 3-4 more months and to start daily testosterone injections, after 6 weeks to try to incorporate HCG. I've not decided only whether to start IM or sub-q. I will not risk with sub-q at the beginning because I know many people don't feel optimal there. I just need to find somebody to teach me shallow IM in the delt or other area.

In fact my main concern regarding TRT is fertility because I dont have kids. I will freeze sperm but I know it does not give 100 percent guarantee it will keep all its qualities especially after 5 years. I know many guys cannot handle HCG and I assume the worst case scenario I will not feel well on it as well. In fact I've tried 2 HCG injections spread in time, 500 and 100 units and I felt very slugish after them. I know its different when you do it regularly with test, but still..

On the other side I really want to start feeling vigorous, energetic and to have my mental clarity back.

What do you think about my situation?

 

[Miironleg]

Start with fixing thyroid, you're hypothyroid

 

[Vonko1988]

Start with fixing thyroid, you're hypothyroid

Already doing that as mentioned, although I know T3 is not a good long term solution. Defy told me to try to increase to 25mcg per day, but to be honest Im afraid to go over 12.5mg in order not to shut down thyroid permanently.

You say Im hypo, but my FT3 is not terrible? And to what extend fixing it can increase my testosterone production?

 

[Systemlord]

I would start TRT and dial in the dosage and then add HCG much later, but not after 6 weeks of starting TRT because you will need more time for your body to balance out otherl hormones.

You really need to get thyroid levels optimal because TRT will not work well when thyroid hormones are not ideal.

 

[Vonko1988]

I would start TRT and dial in the dosage and then add HCG much later, but not after 6 weeks of starting TRT because you will need more time for your body to balance out otherl hormones.

You really need to get thyroid levels optimal because TRT will not work well when thyroid hormones are not ideal.

Wouldn't the 12.5mg Lyothironine fix thyroid for now? Due to the Reverse T3 I'm recommended to take only that for now, but later I guess I will switch to NDT once RT3 problem is solved.

 

[Miironleg]

Already doing that as mentioned, although I know T3 is not a good long term solution. Defy told me to try to increase to 25mcg per day, but to be honest Im afraid to go over 12.5mg in order not to shut down thyroid permanently.

You say Im hypo, but my FT3 is not terrible? And to what extend fixing it can increase my testosterone production?

Not terrible but also not optimal.

 

[Vince]

I agree with the others that said, get your thyroid levels be as perfect as you can. Then decide on trt.

 

[Vonko1988]

Do you think it's dangerous to increase T3 more than 12.5 mcg per day? At what dose a shut down is more likely to occur?
I know some body builders that have taken T3 but only for short period of time...
I will take only few blood tests next week, not yet total like these ones. Should FT3 be tested before I take my morning dose?

 

[Vonko1988]

Seems I've got some form of adrenal fatigue, maybe not strong yet. But it hinders me to raise T3 drug. If I go over 6.25mcg to 12.5mcg I start to get hyper symptoms. These are saliva cortisol tests I've done june 2018:

Cortisol, morning 6-10h sal 28.61nmol/l 0 - 24.10 ECLIA
Cortisol, afternoon 16-20h. sal 0.92nmol/l 0 - 9.65 ECLIA
Cortisol, night 23:30-0:30h. sal 2.59nmol/l 0 - 11.30 ECLIA

These are the recommendations from stopthethyroidmadness:

Here are the consistent results of people who do not have an adrenal problem, which is also your target when on adrenal cortex or hydrocortisone:

• 8 am (or when you normally wake up): at the tip top part of the range (if top of range is 9.5, people are right there, or 9.4, etc)
• 11 am-noon (or approx. 4 hours after you woke up): in the upper quarter, closer to the bottom of that quarter
• 4-5 pm (or approx. 4-5 hours after the above): right “around” mid-range
• Bedtime: at the very bottom (Literally. So if range is 1-4, people are at 1, not even 2)

Clearly I deviate. I need to order another saliva cortisol now and test again, but seems I also have some of the symptoms:

Fatigue, anxiety, light-headedness, shakiness, dizziness, nausea, feeling unrefreshed after getting up in the morning, insomnia, waking up in the middle of the night, difficulty dealing with stressful situations, overreacting, overly defensive…plus problems raising NDT or T3. Dr. Rind says “Most people have a mixture of poor thyroid and poor adrenal function rather than purely one or the other, and therefore a mixture of symptoms”.

I underlined the once I have.

What I could not understand is how to fix this.

Some schools of thought say TRT can fix adrenal issues like that.

 

[Vettester Chris]

12.5mcg is only = to 1/2 grain. Don't worry about the TRH/TSH axis, it's pretty tenacious, and it will still be active when you're medicating, just at lower levels. My TSH ranges from 1.3 to 1.8 on 1.5 grains/day. I had labs done at one point when I was not feeling good, so I laid off the thyroid meds for a few days and my TSH was 3.70. It's not like LH/FSH crashing when you take testosterone or other anabolic compounds.

 

[Vonko1988]

12.5mcg is only = to 1/2 grain. Don't worry about the TRH/TSH axis, it's pretty tenacious, and it will still be active when you're medicating, just at lower levels. My TSH ranges from 1.3 to 1.8 on 1.5 grains/day. I had labs done at one point when I was not feeling good, so I laid off the thyroid meds for a few days and my TSH was 3.70. It's not like LH/FSH crashing when you take testosterone or other anabolic compounds.

My worry is not that the dose is high, but that I cannot tolerate a good enough dose of thyroid hormones. If I try NDT I suspect the same will happen.
The source says this can be due to adrenal fatigue and my saliva cortisol and other symptoms match this. Whether that is the case, I dont know and yet I dont know enough about adrenal fatigue, I've ordered a book about it.

 

[Vettester Chris]

Is the book you are getting by Dr. Wilson? Adrenal Fatigue-21st Century Stress Syndrome? If so, it's loaded with good info.

Yes, to answer you, adrenal wellness is crucial with the thyroid, as cortisol will play a vital role with FT3 getting to the cells (as does iron & ferritin). Too low, FT3 will pool, too high due to stress & other variables, T4 will convert at a higher rate to RT3. You're on the right track imo with the STTM info.

FYI, I had my own imbalances with this years back. Nothing was outrageous, but a bit low on the AM and some PM spikes. DHEA in the PM worked miracles for me, as that was the missing link to offset the spikes and achieve some balance. Sleep quality went up 10 fold as well! It's worth researching as you're gathering info ...

 

[Vonko1988]

Is the book you are getting by Dr. Wilson? Adrenal Fatigue-21st Century Stress Syndrome? If so, it's loaded with good info.

Yes, to answer you, adrenal wellness is crucial with the thyroid, as cortisol will play a vital role with FT3 getting to the cells (as does iron & ferritin). Too low, FT3 will pool, too high due to stress & other variables, T4 will convert at a higher rate to RT3. You're on the right track imo with the STTM info.

FYI, I had my own imbalances with this years back. Nothing was outrageous, but a bit low on the AM and some PM spikes. DHEA in the PM worked miracles for me, as that was the missing link to offset the spikes and achieve some balance. Sleep quality went up 10 fold as well! It's worth researching as you're gathering info ...

Im reading the STTM book, not Dr. Wilson's.
If these are the optimal values:

• 8 am (or when you normally wake up): at the tip top part of the range (if top of range is 9.5, people are right there, or 9.4, etc)
• 11 am-noon (or approx. 4 hours after you woke up): in the upper quarter, closer to the bottom of that quarter
• 4-5 pm (or approx. 4-5 hours after the above): right “around” mid-range
• Bedtime: at the very bottom (Literally. So if range is 1-4, people are at 1, not even 2)

I was high on the morning(above range), low on the afternoon(almost zero) and high at the evening. I will repeat the test again.

The people in this thread say I need to fix thyroid before testosterone, but seems adrenal fatigue obstructs me from fixing thyroid and other experts say that testosterone can help with adrenal fatigue so Im confused what needs to be done next.

 

[Vettester Chris]

Do you have the complete 4x cortisol results available? And hopefully with DHEA correlation? It would be good to see it on a circadian graph, and plot the DHEA correlation accordingly. I have spreadsheet around here somewhere that will do this...

 

[Vonko1988]

Do you have the complete 4x cortisol results available? And hopefully with DHEA correlation? It would be good to see it on a circadian graph, and plot the DHEA correlation accordingly. I have spreadsheet around here somewhere that will do this...

In the upper post I posted from last summer cortisol:

Cortisol, morning 6-10h sal 28.61 nmol/l 0 - 24.10 ECLIA
Cortisol, afternoon 16-20h. sal 0.92 nmol/l 0 - 9.65 ECLIA
Cortisol, night 23:30-0:30h. sal 2.59 nmol/l 0 - 11.30 ECLIA

Also DHEA-s on this day morning:

DHEA-s S 12.57 µmol/l 4.34 - 12.20

This year my DHEA is a bit lower(9.01), today I gave 4x cortisol to the lab will be ready by the end of the day

Results came out:

Cortisol, morning 08:00 sal 13.13 nmol/ l 0 - 24,10 ECLIA
Cortisol, noon 11:45 sal 9.42 nmol/l 0 - 9,65 ECLIA
Cortisol, afternoon 16:45 sal 2.73 nmol/l 0 - 9,65 ECLIA
Cortisol, night 23:45 sal 2.98 nmol/l 0 - 11,30 ECLIA

I dont is it possible the morning value to be so low because the days before I've been taking Ashwagandha, but Im taking it for the last 7 months

 

[Vonko1988]

I plan to consult a progressive TRT doctor and if he approves I will start TRT next month. I think this will easen my symptoms and balance things with thyroid and adrenals, otherwise I remain caught in Paragraph 22 situation