New guy from Ohio

[munch520]

Hey to all,

A video with John Crisler, Nelson Vergel and Jay Campbell brought me here, so I wanted to come learn more and share my experiences.

I'm 30, recently got a pretty wild blood test back and I'm going to be going down the HRT road. Here's my pertinent details:

-6'1, probably 12-15% body fat, 195lbs, athletic (core lifts 3-4x a week, running a few times a week at 2-3 miles a pop)
-Severe head on car accident (net speed 70+ mph) in 02/2015 resulting in mTBI, I've been told my hormones being out of whack could be because of this
-Severe anxiety, some depression, lethargy, etc. manifested 6 mos later and persisted
-Prescribed 10mg Lexapro, took the easy way out and took it for a while (10 mos) but then tapered off

A buddy recommended I go get a full panel done by a DO here in Ohio that specializes in HRT and related stuff. So here's the #s

Growth hormone: 0.1 ng/ml (5 ng/ml)
IGF-1: 198 ng/ml (>200 ng/ml)
IGF BP-3: 3592 ug/L (4000 ug/L)
ACTH: 33 pg/ml

LH: 3.9 (1.7-8.6 mlU/ml)
FSH: 2.8 (7 mlU/ml)
Total Test: 987 (348-1197 ng/dL)
Free Test: 12.4 pg/mL (8.7-25.1 ng/dL)
Estrone: 62 pg/mL (12-72 pg/mL)
Estradiol: 9.8 pg/mL (7.6-42.6 pg/mL)

Cortisol: 10.9 ug/dL (6.2-19.4 ug/dL)

Vit B: 589 pg/mL (211-946 pg/mL)
Vit D: 51 ng/mL (30-100 ng/mL)

'TSH is high, suggests hypothyroidism'
TPO/Thyroid Peroxidase: 220 (<35)
TSH: 7.89ulU/mL (high) (.450-4.5 ulU/mL)
T3 free: 3.6 pg/ml (norm) (>2.5pg/ml)
T4 free: 1.21n g/ml (low) (0.82-1.77 ng/ml)
rT3: 18.9 ng/dL (norm) (8-25 ng/dL)
TSH index: 8.05 (HAP) [1.3 - 4.1] (PI)
T3/rT3 ratio: 19 (low) (>20)

So I was diagnosed with hypogonadism and possible hypothyroidism...which could explain the mental issues I've been experiencing. Treatment right now is as follows:
-Pregnenelone 10mg/day to start
-Clomiphene Citrate 25mg, every 3 days
-DHEA 10mg 2x/day

-Brain DHA and ultranutrident multivitamin on the supplement side

I've delved into the positives and negatives of this HRT courses vs TRT and I like the approach for now, seems more natural and less aggressive to me, we'll see.

My main question, which has received many different responses...is: is hypothyroidsm because of the low T, or are the two even related? I'm worried I might be treating the hormones, when the thyroid is the genesis of all these issues...

 

[CoastWatcher]

Welcome to Excelmale. We hope you'll be an active member. When posting any lab values we need to see the reference ranges. Every lab calibrates and reports at a different reference range; in isolation, the picture isn't clear. Did I miss your total testosterone level? I see the free testosterone, but where is your total testosterone sitting? Why did the doctor run an estrone level, and was the estradiol test the sensitive, LC, MS/MS methodology? You didn't run a salivary cortisol study, to capture daily variation?

To to not zero in on the thyroid is a big mistake. To your doctor's credit, he did give it a good look. It is certainly possible that hypothyroidism is the devil in these details. Is it being ignored, despite the clear indication that there are problems?

 

[munch520]

Thanks for the feedback - I added the values I could find quickly. I added total testosterone too above. This was a LabCorp test by the way if that matters.

Methodology was "Roche ECLIA", as far as why he ran it...I'm not sure! And no, it was an AM test, post fasting so the only cortisol I have is an AM #.

He did note them, but didn't seem to trust the numbers completely. And wants to take a closer look again in 2-3 months to see how the treatment is going and if the thyroid numbers remain out of whack. I do like him, his reviews are good and my friend that suggested him has had success but I am curious about this approach. So I'm seeing my general practice guy tomorrow (also a DO) and I'm going to ask him about referring me to an endocrinologist to get their perspective. Without the thyroid numbers, I agree with and want to try the clomid (due to the low LH/FHS numbers)...but the thyroid numbers are super high from what I've seen and I don't want to ignore that.

But then again, could the thyroid levels be elevated because I had recently stopped the Lexapro? Or something like that

 

[CoastWatcher]

Thanks for the feedback - I added the values I could find quickly. I added total testosterone too above. This was a LabCorp test by the way if that matters.

Methodology was "Roche ECLIA", as far as why he ran it...I'm not sure! And no, it was an AM test, post fasting so the only cortisol I have is an AM #.

He did note them, but didn't seem to trust the numbers completely. And wants to take a closer look again in 2-3 months to see how the treatment is going and if the thyroid numbers remain out of whack. I do like him, his reviews are good and my friend that suggested him has had success but I am curious about this approach. So I'm seeing my general practice guy tomorrow (also a DO) and I'm going to ask him about referring me to an endocrinologist to get their perspective.

Your total testosterone was 987????? That is spectacular! How can he say you're hypogonadal? Something isn't right here...

 

[munch520]

Your total testosterone was 987????? That is spectacular! How can he say you're hypogonadal? Something isn't right here...

He was more concerned with Free T, since he said that's what's actually bio-available.

 

[CoastWatcher]

He was more concerned with Free T, since he said that's what's actually bio-available.

Your free testosterone isn't bad. What are the DHT and SHBG levels? Don't tell me, he didn't run those labs. You clearly are dealing with hypothyroidism, which could well account for what you are facing in regard to your health, and the doctor you are consulting is chasing free testosterone values, a number that is known to be notoriously difficult to quantify in the laboratory. You aren't being well served by this man. Which isn't your fault, the members here are full of stories about the failure of doctor after doctor. But to consider you hypogonadal...that my merit an award of some sort.

 

[munch520]

Your free testosterone isn't bad. What are the DHT and SHBG levels? Don't tell me, he didn't run those labs. You clearly are dealing with hypothyroidism, which could well account for what you are facing in regard to your health, and the doctor you are consulting is chasing free testosterone values, a number that is known to be notoriously difficult to quantify in the laboratory. You aren't being well served by this man. Which isn't your fault, the members here are full of stories about the failure of doctor after doctor. But to consider you hypogonadal...that my merit an award of some sort.

Whoops sorry he did!

DHT: 38 (30-85 ng/dL)
SHPG: 31.2 (<45 nmol/L)

Yeah, idk. Thankfully insurance covered labs. But I'm already hundreds of dollars into it with the meds and consultation on the HRT side. Plus a monthly monitoring fee, so depending on what guidance I get at my 2nd opinion appt...not sure what route I'll go.

Then again, I have read publications/heard doctors talk about how HRT in this method can help stabilize the thyroid. But you're right, that may just be covering up a larger issue.

 

[CoastWatcher]

Deal with your thyroid issues, please, instead of treating a man with a total testosterone level in the 900s for hypogonadiam. The thyroid numbers are calling out for attention. What did he expect to happen with the protocol he gave you?

http://www.issam.ch/freetesto.htm

Did he discuss what a reasonable percentage would be for unbound testosterone? Have a look at this link and you'll find you are not in bad shape at all.

 

[munch520]

He didn't but thanks for that link. I'll check it out!

I think he got on the hypogonadism from linking my head injury to the low LH and then resulting low free T. And also said that the HRT increasing testosterone could also help with thyroid hormone uptake or something

 

[HarryCat]

I certainly agree with CW, this doctor is not serving you well. You are clearly hypothyroid and he is going off on a tangent. A second opinion is a wise move. If you spend time on this site and do some searching you will find that the general consensus is to treat hypothyroidism first and then go after hypogonadism if it is still present.

 

[CoastWatcher]

I truly don't know what he expects to get out of the protocol he designed for you. And to leave your thyroid in its less than stellar state...it's beyond puzzling. It's a cliche to refer to the thyroid as the master gland, but it's true. Deal with that first.

As as for your expenses to date, I do understand that the money is a factor, but so is your health. Consider a second opinion/consultation with Dr. Justin Saya, of Defy Medical (I'm not a Defy patient, I have no vested interest in their practice). He is a member here, and one of the leading practitioners in this field. It would be time and money well spent.

By by the way, you should never, in my opinion, become affiliated with a practice that charges you a monthly "monitoring fee."

 

[Vince Carter]

That may be the highest TSH I've ever seen.

 

[munch520]

I certainly agree with CW, this doctor is not serving you well. You are clearly hypothyroid and he is going off on a tangent. A second opinion is a wise move. If you spend time on this site and do some searching you will find that the general consensus is to treat hypothyroidism first and then go after hypogonadism if it is still present.

Thank you for the feedback, yes I agree the more I learn it seems that the HRT to address testosterone, in the face of the other results, is like trying to stop a leaky tire by continually pumping air into it (instead of patching the leak).

I truly don't know what he expects to get out of the protocol he designed for you. And to leave your thyroid in its less than stellar state...it's beyond puzzling. It's a cliche to refer to the thyroid as the master gland, but it's true. Deal with that first.

As as for your expenses to date, I do understand that the money is a factor, but so is your health. Consider a second opinion/consultation with Dr. Justin Saya, of Defy Medical (I'm not a Defy patient, I have no vested interest in their practice). He is a member here, and one of the leading practitioners in this field. It would be time and money well spent.

By by the way, you should never, in my opinion, become affiliated with a practice that charges you a monthly "monitoring fee."

This doctor helped me to uncover these issues and it seems he ran a pretty extensive panel and for that I am thankful. So the money hasn't been completely wasted, but yes I agree the monthly fee was odd.

That may be the highest TSH I've ever seen.

That and the TPO is what 'scares' me the most I suppose. I don't know if a pituitary can burn out, but it seems like it's working in overdrive trying to stimulate my thyroid. Which is still producing some hormone it looks like, but with that high of TSH, I would assume T3, T4, etc. should be higher.

But TPO might explain that from what I understand...if my body is slowly destroying the thyroid, it's no wonder TSH is being pumped in to try and stimulate the thyroid...? Maybe...idk.

Haha I'm still trying to grasp at understanding all this, but I look forward to seeing my GP today and discussing referrals to other specialists!

 

[munch520]

OK I better understand his approach now, after more explanation. The original doc I saw explained it a little more and his view is that the thyroid issues are more nutrient-deficiency based. He's not ruling out that it could be hypothyroidism or something, but wanted to explore this route first to be conservative. So the ultranutrient vitamin to help the thyroid, DHEA to calm the immune system (lower TPO).

In summation, it's his opinion is that the TSH index (8.05) points to a nutrient deficiency and the thyroid as a peripheral problem.

We'll see what other docs say!

 

[HarryCat]

OK I better understand his approach now, after more explanation. The original doc I saw explained it a little more and his view is that the thyroid issues are more nutrient-deficiency based. He's not ruling out that it could be hypothyroidism or something, but wanted to explore this route first to be conservative. So the ultranutrient vitamin to help the thyroid, DHEA to calm the immune system (lower TPO).

In summation, it's his opinion is that the TSH index (8.05) points to a nutrient deficiency and the thyroid as a peripheral problem.

We'll see what other docs say!

If you want to try a nutrient approach to treating hypothyroidism you should be trying iodine, selenium, and tyrosine. Read Dr. Brownstein's book "Iodine, Why you need it, why you can't live without it"

 

[Vince Carter]

OK I better understand his approach now, after more explanation. The original doc I saw explained it a little more and his view is that the thyroid issues are more nutrient-deficiency based. He's not ruling out that it could be hypothyroidism or something, but wanted to explore this route first to be conservative. So the ultranutrient vitamin to help the thyroid, DHEA to calm the immune system (lower TPO).

In summation, it's his opinion is that the TSH index (8.05) points to a nutrient deficiency and the thyroid as a peripheral problem.

We'll see what other docs say!

Please seek a second/third opinion...that's the craziest stuff right there. The TPO is an absolute concern, google/read about Hashimoto's(?) if you haven't already.

 

[munch520]

If you want to try a nutrient approach to treating hypothyroidism you should be trying iodine, selenium, and tyrosine. Read Dr. Brownstein's book "Iodine, Why you need it, why you can't live without it"

He has me on some of that, selenium at 800mcg/day
http://www.pureencapsulations.com/ultranutrient.html

 

[munch520]

Please seek a second/third opinion...that's the craziest stuff right there. The TPO is an absolute concern, google/read about Hashimoto's(?) if you haven't already.

Yes I have, and with my levels this high I am definitely curious if just nutrient deficiency (which I wasn't super low on on those vitamins) could cause all this. Definitely seeking another opinion.

I definitely appreciate that he wanted to take the most conservative approach, and re-test in 3 months. And I definitely don't want to rush out and have my thyroid yanked out. But I want to consider everything.

 

[munch520]

Diagnosis from second doc is Hashimotos. He's prescribing WP Thyroid (65mg) and says ok to continue with DHEA and Pregnenolone but he says to hold off on the clomid. He says it's also time to go gluten free, which im semi used to anyway (my wife has silicac and rheumatoid arthritis).

Retest in 3 mos. this seems like a more focused treatment, that I'm more inclined to agree with.

 

[HarryCat]

Diagnosis from second doc is Hashimotos. He's prescribing WP Thyroid and says ok to continue with DHEA and Pregnenolone but he says to hold off on the clomid. He says it's also time to go gluten free, which im semi used to anyway (my wife has silicac and rheumatoid arthritis).

Retest in 3 mos. this seems like a more focused treatment, that I'm more inclined to agree with.

The fact that he prescribed WP Thyroid is a good sign, means he is much more progressive than most docs out there. I think you are on the right track, good luck.