Suspect exogenous T3 elevating SHBG and its effects on me

[Marco N Cognito]

Re-evaluating to move forward with TRT yet again (for those that are new or forgot, I have a clotting disorder of unknown origin, so I've held off on TRT because of the recent studies showing it can induce clots in prone individuals).
Last labs showed Total T @ 610, not bad for my natural production at age 54, but my free T is still in the dumps @ 8.4.
SHBG: 48.4 [19.3 - 76.4]
Free Androgen Index: 43.7 [18.0 - 82.0]
Other markers:
E2 is also in the dumps @ less than 3 [3 - 70]
Total Estrogens: 99 [40 - 115]
My take has always been that it's my SHBG that is binding up my total T so WHY NOT TRY TO RESOLVE WHY MY SHBG IS BINDING UP MY TOTAL T BEFORE I START TRT SINCE I MAKE PLENTY OF T?
The problem is that I've tried a number of supps to suppress SHBG and the lowest level I got was 35 which was not enough to boost my free T.
What I think might be a factor is the T3 I need to take for hypothyroid, as T3 has been shown to elevate SHBG.
My dilemma is that I've tried just about everything to reduce SHBG in order to free up free T, but as I've learned, it is a waste of time to try and manipulate SHBG.
Could T3 have been making me hypogonadal?
http://press.endocrine.org/doi/abs/10.1210/jcem-66-4-740

 

[Bass]

have you tried Vitamin D to lower your AHBG?

 

[Marco N Cognito]

have you tried Vitamin D to lower your AHBG?

Took doses up to 10000iu/day. Did nothing.

 

[jger242]

What is your t3 dose and schedule.
Have you tried nettle root extract?

 

[Marco N Cognito]

What is your t3 dose and schedule.
Have you tried nettle root extract?

Yep. Nothing.

I take custom compounded porcine thyroid 3 grains + 30mcg T3 (10mcg 3 x's/day).

 

[jger242]

Thats a lot of t3. If your cortisol levels are not high enough to handle the t3 it will cause you too feel tired or drained easily. If you are not taking hydrocortisone a 4x cortisol saliva test will reveal if that is your problem.

I would also have a ferritin and iron panel blood test done.

If you are not overtraining seriously overstressed under sleeping or not getting enough nutrients then one those 3 are the likely cause.

If you are not experiencing fatigue and elevated shbg is the only concern then the easiest way to lowrr shbg is to lower your t3 dose and retest shbg after 30 days at the reduced dose.

Good luck...

 

[Marco N Cognito]

Thats a lot of t3. If your cortisol levels are not high enough to handle the t3 it will cause you too feel tired or drained easily. If you are not taking hydrocortisone a 4x cortisol saliva test will reveal if that is your problem.

I would also have a ferritin and iron panel blood test done.

If you are not overtraining seriously overstressed under sleeping or not getting enough nutrients then one those 3 are the likely cause.

If you are not experiencing fatigue and elevated shbg is the only concern then the easiest way to lowrr shbg is to lower your t3 dose and retest shbg after 30 days at the reduced dose.

Good luck...

Here's the dilemma:
- I need at least 20mcg + 3 grains dess. thyroid (which provides another approx. 27mcg T3) in order to get T3 in the upper range close to 4. If I cut the T3 dose down too low, my level will drop.
- Cort levels are adequate from last 4 x's saliva as are iron and ferritin.
- I thought I had low cortisol before and took Isocort which raised it too high. Not taking any cortisol boosters now.

 

[Vettester Chris]

Marco, how does your Reverse T3 look compared to Free T3? If the ratio is adequate then it's a pretty good signal that FT3 is effectively getting into the cells. Would be interested to see your FT4 & FT3 lab numbers in comparison to the dosage of your medications. I have read where Cytomel T3 can be more of a factor with elevated SHBG, as opposed to taking NDT or a T4 only medication. Whether that's true or not, I don't know (?), just something I read at one point.

Other factors like genetics can play into this as well. In my case my SHBG remains low (9ish, 10ish range) regardless of my thyroid medication. I try to keep my FT4 and FT3 around the 60% to 70% area of the reference range, and RT3/FT3 ratio above 20. That works for me, but obviously everyone has different needs.

Not sure where you're at with thyroid support supplements, but some added selenium and iodine (if deficient) might enhance the activity and conversion of T4 to T3, thus possibly allowing you to deviate or eliminate the Cytomel dosage. For some it's just not possible since the NDT's don't have the same ratio of T4/T3 as normal human thyroids.

 

[Marco N Cognito]

Marco, how does your Reverse T3 look compared to Free T3? If the ratio is adequate then it's a pretty good signal that FT3 is effectively getting into the cells. Would be interested to see your FT4 & FT3 lab numbers in comparison to the dosage of your medications. I have read where Cytomel T3 can be more of a factor with elevated SHBG, as opposed to taking NDT or a T4 only medication. Whether that's true or not, I don't know (?), just something I read at one point.

Other factors like genetics can play into this as well. In my case my SHBG remains low (9ish, 10ish range) regardless of my thyroid medication. I try to keep my FT4 and FT3 around the 60% to 70% area of the reference range, and RT3/FT3 ratio above 20. That works for me, but obviously everyone has different needs.

Not sure where you're at with thyroid support supplements, but some added selenium and iodine (if deficient) might enhance the activity and conversion of T4 to T3, thus possibly allowing you to deviate or eliminate the Cytomel dosage. For some it's just not possible since the NDT's don't have the same ratio of T4/T3 as normal human thyroids.

I should mention that what I posted on above in this thread was prior to having parathyroid surgery to remove benign parathyroid adenoma, so all bets off now, as I am in a hyperthyroid state. This can happen as a result of the surgery from manipulation of the thyroid:
http://www.ncbi.nlm.nih.gov/m/pubmed/20350919/
http://link.springer.com/article/10.1007/s004230050245

My pre-op ratio was 24.7. Post-op it is only 15.5. rT3 is @ 20 too high.

Here are my post-op labs compared to pre-op:

TSH: 0.130 (was 1.740 10 days pre-op)
Tg: 101.3 (was 5.0 10 days pre-op)
FT3: 3.1 (was 4.7 10 days pre-op)
FT4: 2.03 (was 1.21 10 dayspre-op)
rT3: 20.0 (was 18.90 10 days pre-op)
TPO: 16 (was 7.0 10 dayspre-op)
TgAb: <1.0 (was same 10 days pre-op)

Pre-op regimen:
1.5grains NDT 2x's daily
10mcg T3 3x's daily

So I stopped taking NDT yesterday because I am making too much T4 and decreased T3 to 10mcg twice daily. Just today, I awoke with an acute spike in blood pressure and pulse. I was already on BP meds (ARB, alpha-beta blocker), so I upped my dose of the a-b blocker which reduced my BP. What doesn't make sense is why I would experience a flare up like this when I had decreased my thyroid meds, especially NDT which contains more T4 than T3.