TRT + Thyroid: Recent Labs

[Wolverine]

Had labs done recently. Im on trt as follows:
60mg of test cypionate twice per week (every 3.5 days)
250iu HCG EOD
50mg of DHEA micronized and 100mg of Keto 7 DHEA every day
50mg of pregnenlone micronized every day
2 grains of NP thyroid per day, along with 12.5mg of iodine per day
One day prior to labs started 50mg of Zinc twice per day along with 2mg of copper twice per day (for E control)
Was doing some low level progesterone cream (10mg per day) for about two weeks but stopped this about 3 weeks before labs.

My lab results (fasting, done first thing in the morning on trough day before injection) are as follows:
CBC and Chem profile all in range with exception that my BUN/crearinine level was a little high (22, 9-20)
Iron panel: Serum 70 (40-155), Iron Sat % 20 (15-55) Ferritin 82
Total T: 632 (348-1197)
Free T: 25.5 (7.2-24) H
Estradiol Sensitive: 18.7 (8-35)
Progesterone: 1.8 (.2-1.4) H
SHBG: 18.8 (19.3-76.4) L
DHT: 77 (30-85)
A1C: 5.7 (4.8-5.6) H
FT4: .93 (.82-1.77)
FT3: 3.0 (2-4.4)
DHEA-S: 736 (71.6-375.4) H
Cortisol: 17.8 (2.3-19.4)
TSH: .173 (.45-4.5) L
Prolactin: 9.2 (4-15.2)
Reverse T3: 21.4 (9.2-24.1)
Vitamin D: 53 (30-100)
Vitamin B12: 874 (211-946)

Symptoms: Fatigued, weakness, especially in the legs, lack sex drive, erections hit and miss, some bloating (especially in the evenings after eating) and shortness of breath, some pins and needle type pain in feet that comes and goes. Throughout the day I eat well at work but then when I go home I seem to be starving and eat much more in the evenings.

I think I need to focus on my thyroid numbers as my FT4 seems low, but my FT3 seems ok (maybe could be a smidge higher). Has anyone added synthetic T4 to NDT regiment? Wondering about that option versus just raising my NDT another grain. Seems I need to boost my T4 more than my T3. If it wasnt for my E results I would think I was high in E by my symptoms. I was going to ask my doc for some arimidex but probably wont be able to now with these lab results. I need to reduce my DHEA supp a tad.

Any and all thoughts, insight and comments appreciated. Thanks.

 

[Nelson Vergel]

Are you sleeping OK?

How long have you been on TRT and thyroid med?

Yes, you could use some more free T4. Your TSH is not fully suppressed so that tells me you can go up on NDT dose some. Chris can add more on this subject.

Your glucose may be above normal (higher A1C). How is your diet?

For bloating, read this if you can (specially the info about high FODMAP foods to avoid): https://www.excelmale.com/forum/threads/bloated-and-swollen-on-testosterone-what-tests-to-run.10497/

I can tell you are educated since your protocol is actually pretty on point.

 

[Gene Devine]

Looks like you've been doing your research around here; your protocol is spot on!

I really don't see anything in your labs that would point to your symptoms; FT4 a bit low possibly but I highly doubt it would be causing the symptoms you are having.

In fact, you could probably increase your Testosterone dosage as the 900's may be better for you then the 600's.

Cortisol is not over the reference range but it's up there and could possibly be one contributing factor.

Are you stressed in your job or life in general?

Other than that; you look really good!

 

[Wolverine]

Thanks Nelson! I am having trouble sleeping. I have been on trt and thyroid meds for 3 years and trying to fine tune. I have a stressful job and have some personal stressors. My glucose was 94 (65-99). First time my A1C has been high, albeit with summer here I love ice cream and sweets so that may explain it. I workout 4 times a week and ride a bike 3 times a week. Im in decent shape. I read the referenced thread and the point about impaired glucose seems to apply. I did have H Pylori and was successfully treated for that. Anything I can do for the impaired glucose tolerance? Thanks!

 

[Wolverine]

Thanks Gene. I do have some stressors, inclduing my job. I may raise my T a little but my free T is already over the top, but if I raise my NDT that could increase my SHBG and lower my Free T. Should I lower my DHEA dosage or is the 700 range ok? Thanks!!

 

[Vettester Chris]

I don't have too much time, so I'll make it quick ...

You appear to have some pooling problems with T3. Your FT3/RT3 ratio is at 14 ... Needs to be above 20, or IMO better yet at 25 or better.

Besides the RT3 marker, as Gene observed, your FT4 is at the low end of the ref range. Why? More than likely due to a higher conversion rate going to RT3.

Reasons? First main one that sticks out is your Iron. For my .02 of it, iron serum under 100 is asking for problems with the thyroid, especially on thyroid medication. I strongly feel aiming for the 120 - 135 mark is ideal, not only for optimal T4 to T3 conversion, but for ensuring FT3 is circulated in the body, in conjunction with cortisol and the adrenals. Banking your B12 also may need addressed, and/or D3 & Magnesium. You stated the stress subject and so forth, and to make any real determination you NEED to acquire a 4x Saliva panel - Cortisol w/DHEA correlation. The 1x blood serum lab gives little information about the state of your adrenals.

See what you can find, and do some research on what I have mentioned, you will find a lot out there on this stuff. Dr. Bruce Rind has some good info., as does the books from Dr. James Wilson (not the same guy from House BTW).

 

[Wolverine]

Thanks Chris! In your opinion what is the best way to get serum iron up without increasing ferritin too much? Tx

 

[Vettester Chris]

Thanks Chris! In your opinion what is the best way to get serum iron up without increasing ferritin too much? Tx

Some good elemental iron supplements usually works well (140mg - 200mg), along with iron enriched foods, and even cooking on the old iron skillet that grandma used to have. I would ramp up your vitamin C intake at the same time, maybe implementing a 2x daily routine .. Could be 80mg of elemental iron and "x" amount of C (find out your tolerance point) .. Maybe not a Dr. Klenner amount protocol, but "enough" to help compliment the iron protocol and make it optimal.

Again, beyond that, review your Vitamin D (which is actually a hormone), my suggestion is to aim for the 60ng/dl to 80ng/dl area, and again B12 and magnesium might need addressed.

FYI, Defy Medical has a great supplement therapy called CALM, which has a great blend of Magnesium & GABA, which could be a great night time supplement to consider on your end! The adrenals will still need a 4x saliva kit with Cort/DHEA correlation for anyone (doctor or not) to provide any useful comments. Your DHEA correlation will actually be derived from the SUM & Avg. of your Afternoon and Early PM cortisol result, so doing doing a 1x morning draw leaves a myriad of speculaton.

 

[Wolverine]

Thanks Chris! I forgot to mention that I give blood regularly so I think I will stop that for a while.