Post Graves - Low Test - Need help

[fenstermaker]

I am a 38 year old male that is post Graves. The treatment I received for Graves was iodine radiation which in turn zapped my Thyroid completely. Currently on 175mcg of synthroid. I have never felt "normal" since. That was about 6 years ago. I put on about 45 pounds and have never been able to lose the weight.

I insisted my Dr check more of my levels than my T3, T4 to see why I feel like crap all the time.
My results came back a follows:

fsh=2.8 in range
LH=4.6 in range
IGF-II=1107 in range
GH= 1.7 in range
Test Total = 196 Low
Test Free %= 2.32
Test Free = 45

After this test result in the beginning of Aug 2006, My Dr put me on Androgel. 2.5 grams daily.

That is when I started my research and found this site. Since my readings, I thought the amount he started me on was very low for a guy my age and size. 38 6'3" 245lbs.

Included in my reading from you guys, you insisted that I make my Dr check my levels again in approx four weeks.....I had to make my Dr agree to this and he did new results are as follows:

Alkaline phosphatase 62
AST 15
ALT 17
Bilirubin total 0.9
Bilirubin Direct 0.2
Protein, Total 7.1
Albumin 4.5

Estrogens Total 96

Test, Total 176
Test % free 2.30
Test, free 40.5

DHT 36


So I recieved a note from my Dr with the test results to increase the Androgel to 5 grams daily and run new tests in 3 months.

I am not thrilled by the new test numbers but I have you talk about the possibility of Test dropping in the first stages. I am not convinced my Dr is completely ready for this challenge that I am facing and he has not suggested that I seek another Dr.

So if anyone can give some input on the relationship of Post Graves to the low test situation I am facing, or if there is no relationship between the two. Also if anyone can suggest a good Doc in the Columbus, Ohio area.

Thanks for sharing you thoughts and time to post, for it has helped me get ready for this TRT journey that I was not aware even existed. The personal situations that you all talk about help relate for us new guys in this problem.

fenstermaker

[pmgamer18]

Originally Posted by fenstermaker

I am a 38 year old male that is post Graves. The treatment I received for Graves was iodine radiation which in turn zapped my Thyroid completely. Currently on 175mcg of synthroid. I have never felt "normal" since. That was about 6 years ago. I put on about 45 pounds and have never been able to lose the weight.

I insisted my Dr check more of my levels than my T3, T4 to see why I feel like crap all the time.
My results came back a follows:

fsh=2.8 in range
LH=4.6 in range
IGF-II=1107 in range
GH= 1.7 in range
Test Total = 196 Low
Test Free %= 2.32
Test Free = 45

After this test result in the beginning of Aug 2006, My Dr put me on Androgel. 2.5 grams daily.

That is when I started my research and found this site. Since my readings, I thought the amount he started me on was very low for a guy my age and size. 38 6'3" 245lbs.

Included in my reading from you guys, you insisted that I make my Dr check my levels again in approx four weeks.....I had to make my Dr agree to this and he did new results are as follows:

Alkaline phosphatase 62
AST 15
ALT 17
Bilirubin total 0.9
Bilirubin Direct 0.2
Protein, Total 7.1
Albumin 4.5

Estrogens Total 96

Test, Total 176
Test % free 2.30
Test, free 40.5

DHT 36


So I recieved a note from my Dr with the test results to increase the Androgel to 5 grams daily and run new tests in 3 months.

I am not thrilled by the new test numbers but I have you talk about the possibility of Test dropping in the first stages. I am not convinced my Dr is completely ready for this challenge that I am facing and he has not suggested that I seek another Dr.

So if anyone can give some input on the relationship of Post Graves to the low test situation I am facing, or if there is no relationship between the two. Also if anyone can suggest a good Doc in the Columbus, Ohio area.

Thanks for sharing you thoughts and time to post, for it has helped me get ready for this TRT journey that I was not aware even existed. The personal situations that you all talk about help relate for us new guys in this problem.

fenstermaker

Wow your Dr. is not up in treating your Problems but you sound like he will work with you. Here is what happened you started on a dam low dose of Androgel 2.5 grams taking this looks like it stopped your brain from sending the LH and FSH messages to your tests so your levels went down. In the insert that comes with Andorgel it states to test in 2 weeks after starting on 5 grams to be sure your levels are good. Now you up to 5 grams so be sure you read this and make your Dr. test you in 4 weeks and keep testing you every 4 to 6 weeks until your stable. What are you on for your thyroid must of us here do dam good on Armour read this link.
http://www.stopthethyroidmadness.com/
When you test again be sure to do Free T3 and Free T4 for your thyroid and have your Cortisol levels checked I am betting your low. If you still feel your Dr. is not up on this ask him if he will treat you with Dr. John over the Phone. Go to www.allthingsmale.com and read TRT: A Recipe for Success and his HCG Update. Most of us do this for treatment if your Dr. will not do this you can drive up here to MI. and see him and back in one day.

[fenstermaker]

how long should it take for the Androgel to kick in? I am on Synthroid 175mcgs.....I will check the free t3 t4 and cortisol.....next test and update on the results.

Thanks

[pmgamer18]

Originally Posted by fenstermaker

how long should it take for the Androgel to kick in? I am on Synthroid 175mcgs.....I will check the free t3 t4 and cortisol.....next test and update on the results.

Thanks

If your on a good dose and it gets through your skin you should feel something in a week but it is not big jump it is a slow process you feel a little better each day. Synthroid is in my opinion not good for Thyroid problems. My wife was on it for 15 yrs and she went from one Endo to the other telling them she dose not feel good and they all said your levels are good. Mybe your depressed or lose weight WTF is with them. She found a Dr. that treats with Armour and now she is doing much better. Here is a good site about this.
http://www.stopthethyroidmadness.com/

[fenstermaker]

THanks for the advise.........If you don't have any Tyroid function at all, will Armour still work? Since the iodine radiation, there is no tyroid function at all in my body. I have noticed in the first few weeks that my testes have shrank. What do you do?

[pmgamer18]

Originally Posted by fenstermaker

THanks for the advise.........If you don't have any Tyroid function at all, will Armour still work? Since the iodine radiation, there is no tyroid function at all in my body. I have noticed in the first few weeks that my testes have shrank. What do you do?

Yes hell yes my wife had this done and she is doing much better then ever on Armour. You need to read the link I gave you.

[marianco]

Originally Posted by fenstermaker

I am a 38 year old male that is post Graves. The treatment I received for Graves was iodine radiation which in turn zapped my Thyroid completely. Currently on 175mcg of synthroid. I have never felt "normal" since. That was about 6 years ago. I put on about 45 pounds and have never been able to lose the weight.

I insisted my Dr check more of my levels than my T3, T4 to see why I feel like crap all the time.
My results came back a follows:

fsh=2.8 in range
LH=4.6 in range
IGF-II=1107 in range
GH= 1.7 in range
Test Total = 196 Low
Test Free %= 2.32
Test Free = 45

After this test result in the beginning of Aug 2006, My Dr put me on Androgel. 2.5 grams daily.

That is when I started my research and found this site. Since my readings, I thought the amount he started me on was very low for a guy my age and size. 38 6'3" 245lbs.

Included in my reading from you guys, you insisted that I make my Dr check my levels again in approx four weeks.....I had to make my Dr agree to this and he did new results are as follows:

Alkaline phosphatase 62
AST 15
ALT 17
Bilirubin total 0.9
Bilirubin Direct 0.2
Protein, Total 7.1
Albumin 4.5

Estrogens Total 96

Test, Total 176
Test % free 2.30
Test, free 40.5

DHT 36


So I recieved a note from my Dr with the test results to increase the Androgel to 5 grams daily and run new tests in 3 months.

I am not thrilled by the new test numbers but I have you talk about the possibility of Test dropping in the first stages. I am not convinced my Dr is completely ready for this challenge that I am facing and he has not suggested that I seek another Dr.

So if anyone can give some input on the relationship of Post Graves to the low test situation I am facing, or if there is no relationship between the two. Also if anyone can suggest a good Doc in the Columbus, Ohio area.

Thanks for sharing you thoughts and time to post, for it has helped me get ready for this TRT journey that I was not aware even existed. The personal situations that you all talk about help relate for us new guys in this problem.

fenstermaker

Good thyroid hormone actilvity is necessary for testicular steroid hormone production - e.g. testosterone production.

Low thyroid hormone activity often results in insulin resistance.

Insulin resistance is another factor that reduces testosterone production. It interferes with LH production and may also directly reduce testicular testosterone production.

The bests tests for available thyroid hormone activity are:
Free T3, Free T4, and TSH.

The free T3 is the most important of the three since it measures the most active thyroid hormone. T3 is about 4 to 10 times more active than T4. It is what the brain measures to determine how much TSH to release.

Synthroid (T4) is not as effective in treating hypothyroidism as a combination of T4 and T3 such as Armour Thyroid. In studies comparing T4 versus T4+T3, patients strongly preferred T4+T3 even if there were no difference in the lab levels. They simply felt better. Armour Thyroid is safer to use versus the available T4+T3 combinations since the thyroid hormone in Armour Thyroid is bound to thyroid binding globulin, and is then slowly released into the body when it is absorbed. Thus Armour Thyroid is a long-acting version of thyroid hormone. This is in contrast to the other T4+T3 combinations or T3 (Cytomel) itself. The problem is the sudden rise in T3 from these has a higher risk of causing problems including cardiac arrhythmias. It is technically more difficult and requires closer physician monitoring to use other T4+T3 combinations and T3 in treating hypothyroidism.

A good starting point is that a person may often show signs and symptoms of hypothyroidism when the free T3 is less than 310 pg/dL.

More important than blood levels of thyroid hormone is whether or not there are still signs and symptoms of hypothyroidism with treatment. There are a large number of people with normal thyroid hormone levels (normal free T3, free T4, TSH), yet who still have signs and symptoms of hypothyroidism. These people have thyroid hormone resistance and need extra thyroid hormone treatment.

When it comes to LH and FSH, the question is not whether or not the values are in range, but whether or not the appropriate amount of testosterone is being made in response to the LH level. This helps determine if one has a problem with the pituitary's production of LH (secondary hypogonadism) or if the problem lies in testicular production (primary hypogonadism) or if there is both primary and secondary hypogonadism.

Since there are multiple factors which can affect testosterone production both from the hypothalamus-pituitary and testicular ends - such as other hormone imbalances - the LH and FSH may not so much be useful except to determine if a pituitary tumor is present or if HCG can be used as TRT (as with secondary hypogonadism).

Total testosterone is the best test for clinical purposes. The tests for free testosterone are not uniformly accurate enough. Free testosterone can also be normal yet a person has all the signs and symptoms of hypogonadism.

A good target for total testosterone during TRT is at least 650 ng/dl, measured at the midway point between injections or at least four hours after applying transdermal testosterone, or any time if pellets are implanted.

Its better to measure estradiol than total estrogens to get an idea of the total estrogen activity. Estradiol level is in essence the total estrogen level but with greater weight placed on estradiol itself and less weight placed on the other estrogens (which are much weaker than estradiol).

During testosterone replacement, the total testosterone is determined by how much testosterone the testes make plus how much external testosterone is absorbed. There is a point where the external testosterone dose is high enough to shut down testicular testosterone production but not enough to make up the difference. In this case, the total testosterone actually is lower with TRT than without. The solution is to increase the external testosterone dose to a point where it is high enough to increase total testosterone rather than reduce it.

When it comes to Androgel, a dose of 5 grams of gel causes a substantial percentage of men to worsen in hypogonadism (i.e. lower total testosterone). Many men do respond well and have really good levels - e.g. 750 ng/dl and above. But to reduce the risk of worsening testosterone levels, starting at 10 grams then lowering the dose if total testosterone, DHT, estradiol levels go too high or of side effects occur, may be preferrable.

When a person has had hypothyroidism for a long time, absorption of transdermal testosterone may be difficult. This is because there is a build-up of mucin (a glue-like substance) in the skin of people with hypothyroidism, which causes the skin to become thick. This is called myxedema. It can be subtle, not obvious to most physicians, who are not use to pinching the skin of their patients to gauge the thickness of the skin. Myxedema impairs absorption of transdermal testosterone - impairing treatment with transdermal testosterone.

When myxedema is present, it is better to go to testosterone injections for TRT.

[fenstermaker]

Thank you for your responses..... I greatly appreciate your insight. I will discuss with my Dr and insist that he checks for the balace levels of my T3 and T4. To date he has only been concerned with my T4 level. We did try straight Cortisol (T3) but is gave me the jitters and heart palpatations. I will ask his opinion about Armour and do some more research on the product.

If my Test levels have dropped since the introduction of Androgel, and my testes are definately shrinking... should I believe that my body is absorbing the Androgel? Is there something to do for the shrinkage, and low seman discharge?

Thanks again for your suggestions.

[JanSz]

Originally Posted by fenstermaker

If my Test levels have dropped since the introduction of Androgel, and my testes are definately shrinking... should I believe that my body is absorbing the Androgel? Is there something to do for the shrinkage, and low seman discharge?

Thanks again for your suggestions.

I have a little theory here and would like confirmation from somebody who have a real know how.
---------------------
It would help if you had your Testosterone levels pre-radiation treatment, if not I assume you testis were in good working order and you had a decent T level, then. In August 2006 you started correcting your T level using insufficient amount of Androgel, with mixed success, so far. Per my theory, you should have started working on getting your thyroid T's (T1,T2,T3, T4) plus adrenals, in order as first phase of treatment. And as a second phase, work on correcting your testosterone. There is a good chance that all you are really need is a Thyroid hormones lined up correctly, they also regulate Testosterone production.
-------------------
As to immediate problem of shrinking testis, HCG is the way to go. Shrinking testis is not only cosmetic problem, whatever else they produce, other than Testosterone, have an effect on libido, ED and over-all feel of well being.
------------------
Good luck finding the right doctor.
Since you a fighting this battle for the last 6 years, one trip to Monterey, California, USA to see Dr Marianco does not seem out of line, (how to contact him?? does anybody know). I thing follow up can be made via phone or e-mail.
Good luck, bro, and keep us posted on your progress.

JanSz

[marianco]

Originally Posted by JanSz

I have a little theory here and would like confirmation from somebody who have a real know how.
---------------------
It would help if you had your Testosterone levels pre-radiation treatment, if not I assume you testis were in good working order and you had a decent T level, then. In August 2006 you started correcting your T level using insufficient amount of Androgel, with mixed success, so far. Per my theory, you should have started working on getting your thyroid T's (T1,T2,T3, T4) plus adrenals, in order as first phase of treatment. And as a second phase, work on correcting your testosterone. There is a good chance that all you are really need is a Thyroid hormones lined up correctly, they also regulate Testosterone production.
-------------------
As to immediate problem of shrinking testis, HCG is the way to go. Shrinking testis is not only cosmetic problem, whatever else they produce, other than Testosterone, have an effect on libido, ED and over-all feel of well being.
------------------
Good luck finding the right doctor.
Since you a fighting this battle for the last 6 years, one trip to Monterey, California, USA to see Dr Marianco does not seem out of line, (how to contact him?? does anybody know). I thing follow up can be made via phone or e-mail.
Good luck, bro, and keep us posted on your progress.

JanSz

Jan, you make great points.

In a person with hypothyroidism due to treatment of Graves Disease, the first order of business is optimization of thyroid hormone activity.

If adrenal fatigue is simultaneously present, then it should be treated just before treatment with thyroid hormone because adrenal fatigue makes it more difficult to tolerate additional thyroid hormone. Treatment of adrenal fatigue can be started simultaneously or a few days before thyroid hormone treatment is started.

Next, if still present, would be treatment of hypogonadism/testosterone deficiency.

It is possible to do all three at once and do fine tuning as time goes on. The follow up appointments don't have to be so far apart. Transdermal testosterone reaches the plateau level within 3 days. It can be adjusted in 1-2 weeks. Armour Thyroid can be adjusted every 2-6 weeks, depending on a person's health - slower for more fragile persons. If injected testosterone is used, then the plateau dose (steady state) is reached faster the more frequent the injections.

HCG is an option in treating hypogonadism. Shrinking testes indicates they still respond to LH, which is reduced with testosterone replacement. The dose varies from 1000 to 5000 IU a week in divided doses. Over time, as one ages, the testes may not respond well to LH, and one may need to go to testosterone replacement. If the dose of HCG is too high, there is a risk of causing resistance to HCG, ending the usefulness of HCG.

Testosterone replacement can be combined with very low dose HCG (e.g. 500 IU a week in divided doses) to keep the functioning of the testes (this is Dr. John Crisler's/SWALE's protocol).

For contact info, send me a PM.

[fenstermaker]

Here are my new results after being on Androgel for 8 weeks. 4 weeks on 2.5 g and 4 weeks on 5 g
And on 175mcg of Synthroid

FSH 0.7 range 1.6 - 8.0
Estradiol 13 range 10-50
Testosterone
TOTAL =238 range 250-1100
%FREE = 2.91 range 1.00-3.10
FREE = 69.3 range 35-155
Dihydrotest..42 range 25-75

TSH 4.34 range .40-5.50
T4 free 1.2 range .8-1.8
T3 free 282 range 230-420

Now that my Dr has started me on Androgel, and with these latest test results he has suggested me to go to an Endo.......Handing me off I guess. I believe I have been feeling better since the start of Androgel, but nothing incredible. I asked my Dr about Armour and also HCG and kind of avoided the questions, stating that there is no proven info on Armour and that the HCG treatment is really only for the "Anti-Aging" platform of medicine. Sounds like I have exhaulted my Dr's knowledge and need to move on for futher treatment. I am not far from Michigan, is Dr John the best solution in this area of the country? Does he even take new clients?

Any suggestions of help are appreciated. I am feeling a little left out in the cold by my Dr.

thanks

[pmgamer18]

Originally Posted by fenstermaker

Here are my new results after being on Androgel for 8 weeks. 4 weeks on 2.5 g and 4 weeks on 5 g
And on 175mcg of Synthroid

FSH 0.7 range 1.6 - 8.0
Estradiol 13 range 10-50
Testosterone
TOTAL =238 range 250-1100
%FREE = 2.91 range 1.00-3.10
FREE = 69.3 range 35-155
Dihydrotest..42 range 25-75

TSH 4.34 range .40-5.50
T4 free 1.2 range .8-1.8
T3 free 282 range 230-420

Now that my Dr has started me on Androgel, and with these latest test results he has suggested me to go to an Endo.......Handing me off I guess. I believe I have been feeling better since the start of Androgel, but nothing incredible. I asked my Dr about Armour and also HCG and kind of avoided the questions, stating that there is no proven info on Armour and that the HCG treatment is really only for the "Anti-Aging" platform of medicine. Sounds like I have exhaulted my Dr's knowledge and need to move on for futher treatment. I am not far from Michigan, is Dr John the best solution in this area of the country? Does he even take new clients?

Any suggestions of help are appreciated. I am feeling a little left out in the cold by my Dr.

thanks

I talk to Dr. John weekly and can tell you he is your best bet go to www.allthingsmale.com and get his number call and talk to kim and drive down and see him I feel you can make the trip in one there and home again. He will treat your Adrenals, Thyroid and low T put you on HCG and get your testis working again. Print out what Dr. Marianco posted and take it with you and your tests. Your Dr. is not up on this you need Armour being on Synthroid can cause Adrenals to become low this is what happened to my wife.

Your Dr. put you on 2.5 grams of Androgel this is not enough but will shut down your testis meaning your brain will see this in your blood and stop sending the LH and FSH to your testis so your T levels go down lower then your base line test. I don't feel the gels are going to work for you if you have Thyroid problems your skin can become very thick and the gels will not get into your blood being on 5 grams shows this because your levels are still way to low.

Dr. John knows what you need I am sending you a PM.

[kincaiddave]

I tried AndroGel and it just didn't work for me. I went up to 10g and that only got my total T up to 331. I've been switched to injections.

At the least you need to switch to 10g and see what your response is, although that's not what I would recommend.

If your doctor won't work with Dr. John, I agree with Phil that you need to go see him or Dr. Marianco or another known excellent Doc in the field.

I screwed around for over a year and am on my fourth Doc now. It looks as if he is going to work out, since he has agreed to consult with Dr. John via phone on my case.

If you go to the endo that your doc is hiking you to, that may work out, but it is a crap shoot. Don't waste your time, money, or your life on the crap shoot.

Good luck!

[fenstermaker]

I have been on TRT for about 4 months and here are my latest labs. I am post Graves, so I have no Thyroid function any longer and I was on 175mcg Synthroid and now I am on Armour at 60gr 2x a day, and 10gr Test gel, 1iu of HGH, Preg cream.

I have felt better after workouts, but I cam extremely tired at the end of the day. I have a hard time seeing 9pm before I fall asleep. I feel my Thyroid levels are not right on Armour and my labs reflect that, so I have to wonder if anyone else is having problems with ARmour.

Any feedback is appreciated.

TESTOSTERONE
total = 383
%free= 2.65
free = 103.1

Lipid panels are all fine.

CBC are all fine
HCG, Serum = <2.0

prolactin = 8.9

Comp metabolic panel are all fine

Insulin =3
progesterone = 0.9

TSH = 7.49 (high)
T4, free = 0.9 (low)
T3,free = 296 (low end)
DHEA = 124
Estradiol = 25

FSH = <0.7 (low)
LH = <0.2 (low)
DHT = 135 (high)
Cortisol = 9.5


The only item that were out of range in August was my Test was at 175....... Now with TRT there are several level out of whack. Is this normal? What is my next step?

Thanks for the help.

[pmgamer18]

I think I see you problems your cortisol is low if this a morning test and you Thyroid is still to low but you will have a hard time doing more armour with low cortisol levels. You need cortisol to carry the thyroid meds out of your blood into the cells. If I were you I would get some Isocort. Your Total and Free T levels are very low and some people with thyriod problems have a problem with thcker skin and that gels don't get trough the skin. If I were you I would get on shots start with 100mgs. do the shot and the gel the same day then drop the gel the next do this shot every week. Get on some DHEA I do 25mgs 2x's a day got me levels up into the 400's at this level I can feel it. Do read the sticky Adrenal Thread and goto this link and read the hole site for your thyroid and adrenals.
http://www.stopthethyroidmadness.com/
Read this link post #4 on how I started treating my adrenals and thyroid taking temps and charting them helps.
Adrenal Fatigue and Wilson's Glandular Extracts

Originally Posted by fenstermaker

I have been on TRT for about 4 months and here are my latest labs. I am post Graves, so I have no Thyroid function any longer and I was on 175mcg Synthroid and now I am on Armour at 60gr 2x a day, and 10gr Test gel, 1iu of HGH, Preg cream.

I have felt better after workouts, but I cam extremely tired at the end of the day. I have a hard time seeing 9pm before I fall asleep. I feel my Thyroid levels are not right on Armour and my labs reflect that, so I have to wonder if anyone else is having problems with ARmour.

Any feedback is appreciated.

TESTOSTERONE
total = 383
%free= 2.65
free = 103.1

Lipid panels are all fine.

CBC are all fine
HCG, Serum = <2.0

prolactin = 8.9

Comp metabolic panel are all fine

Insulin =3
progesterone = 0.9

TSH = 7.49 (high)
T4, free = 0.9 (low)
T3,free = 296 (low end)
DHEA = 124
Estradiol = 25

FSH = <0.7 (low)
LH = <0.2 (low)