Reverse t3 management worth it?

I have Hashimotos and been on thyroid medication for several years now. I made the mistake of not checking reverse t3 from the beginning. After finding out I had very high RT3, (which actually counters free T3) and is caused by my body converting t4 into RT3, I now take compounded sustained release T3 only (no T4 at all). I take 25 mcg twice a day 12 hrs apart. RT3 is now low where it should be and it has made a world of difference. The brain has the most T3 receptors of any organ in the body and T3 is vital in controlling emotions. It helps to control depression and anxiety and mood. Also on trt sub q E3d plus HCG every other day. No Ai needed but do have problems getting my E2 up into range of 22 to 32. HCG plus DHEA will increase E2. Was on transdermel Test, but became hypersensitive after 2 yrs and both test levels and E2 went through the roof. The switch to sub q injections more frequently solved all of my issues. On the transdermel Test I had to take Anostrazol to control E2. Now I have to work at raising my E2 to get to normal levels. Proper E2 levels are absolutely necessary for good nocturnal erections. Which then indicate your body is in good hormonal balance.

Interesting . . . I was just prescribed compounded sustained release T3 (from Empower), however my doc told me to start at 10 mcg once in the morning for 2 weeks, then increase to 20 mcg depending on symptoms, up to a max of 30 mcg. Never said anything about splitting the dose in the am/pm. He actually made a point of telling me to take it with water first thing upon waking and then wait at least 30 min before eating/drinking anything else. I'm now wondering if I should question the doc further on splitting the dose. Or maybe when I get the delivery I will give it a try with just the am dose, and see how I feel in the evenings as my T3 levels will presumably drop?? This Thyroid stuff is very complicated . . .
 
Interesting . . . I was just prescribed compounded sustained release T3 (from Empower), however my doc told me to start at 10 mcg once in the morning for 2 weeks, then increase to 20 mcg depending on symptoms, up to a max of 30 mcg. Never said anything about splitting the dose in the am/pm. He actually made a point of telling me to take it with water first thing upon waking and then wait at least 30 min before eating/drinking anything else. I'm now wondering if I should question the doc further on splitting the dose. Or maybe when I get the delivery I will give it a try with just the am dose, and see how I feel in the evenings as my T3 levels will presumably drop?? This Thyroid stuff is very complicated . . .

With immediate release T3, it’s 100% mandatory to split up your doses throughout the day. It’s not even a question. But with sustained release T3, im really not sure. All I know is that sustained release T3 isn’t very popular, due to it not working well for a lot of people. I forget why it doesn’t work as well as immediate release T3. I remember reading about it a few times, and once I found out that everyone uses immediate release T3, I didn’t feel a need to continue researching the sustained release version.
 
If it is sustained release I would guess your wanting effect on stimulation to be less by bed time. There is a protocol to do with cortisol where you do take it at bed time. T3 levels and cortisol increase together. At bed time cortisol should be lower so you wouldn't take T3 long before bed time. You take T3 when you get up to start the cycle to peak before noon. Immediate release is split up to keep from spiking your levels much like we do with testosterone. One large dose has a totally different effect than two smaller ones. Someone can have overdose symptoms taking one large dose and not have it splitting it up through the day that same dose per day.
 

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TRT Hormone Predictor Widget

TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

ℹ️ Input Parameters

Normal range: 300-1000 ng/dL

Predicted Hormone Levels

Enter your total testosterone value to see predictions

Results will appear here after calculation

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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