Looking for some input ahead of my doc appointment

[Rangeball]

Hello all.

I posted here quite a while back for awhile, and still lurk. I'm a 42 year old male, and I was diagnosed hypothyroid over a year ago, and have been slowly working my way up the armour doseage scale. My doc is a general surgeon and GP, and a family friend. He was out of his comfort zone on the armour and bigger doses I kept requesting since my TSH all but dissapeared but my FT3 and 4 levels were still in the tank. I have a 2.5 grain script for armour from him, and am using thyroid-s to supplement and increasing on my own with help from others who've gone before me. I focused on Thyroid as swale said it can mimic hypogonadism and should be treated first. I found I needed to start isocort as I wasn't tolerating the armour at higher doses, and have been using it for a few weeks now with good results.

In denying my last request for an armour bump, my doc said other things could cause the symptoms I am experiencing, primarily low libido, weaker erections, brain fog, poor memory, low energy and down mood. So I asked to run a bunch of tests, and he agreed. Results were as follows-

Vitamin D Panel*
Vit D, 1,25-Dihydroxy- 47 15-60 range
Vit D, 25-OH, total- 24 20-100 range
Vit D, 25-OH, D3 24
Vit D, 25-OH, D2 <4

*Measurement of 25-OHD2 is an indicator of compliance with supplements. Levels >4 suggest compliance. 25-OHD3 indicates endogenous production. Therapy should be based on measurement of Total 25-OHD, with levels <20 suggesting Vitamin D deficiency and levels between 20 and 30 suggesting a possible need for supplementation.

I am supplementing Vitamin D3 at 4000 IU daily.

Vitamin B-12 469 200-1100 range

From what I've read, while in range it's still low. I supplement sublingual B12 tabs daily.

Estradiol (ultra sensitive) 20 10-50 range. This one suprised me. I was sure it would be eleveated. According to Swale I'm right in the sweet spot, iirc.

Cortisol- 7 5-21 range for males sample taken 8-10 am.

While in range, still low, just like I suspected. I plan to continue the isocort to allow my adrenals to heal since they've obviously been picking up the thyroid's slack.

SHBG- 44 8-46 range. No wonder.

Total Testosterone- 436 250-1100 Much lower than it should be. I'm 42

Free Testosterone- 47.7 35-155 Hmmmm...
% Free Testosterone- 1.09 L 1.1-2.8 range. Not good.

DHEA-S- 257 43-345 range. From what I've read this should be higher. I supplement it now daily with 50 mg DHEA, will switch to 7-keto to avoid estrogen conversion soon.

FSH- 5.6 1.6-8 range
LH- 4.8 1.5-9.3 range Looks like the boys are getting called on, they're just not up to it?

Prolactin- 6.1 2.0-18 range. I've read where this is high for males with prostate cancer, but can't find much for normal males.

Sorry for the long post, but I meet with my doc next thursday to discuss TRT. I've emailed him my thoughts and Swale's protocol. I have drug insurance that would cover androgel, and if transdermal work will eventually compound my own to lower my cost. Pellet therapy sounds interesting, but I don't think my doc does it.

Ahead of my appointment I'm trying to brush up to be prepared. With my results, do I have Primary, secondary or central hypogonadism? I've printed out charts that show the symptoms of low T, I have most of them. I wanted to print out the graph that shows average T levels by age, but that red line that says "recommended treatment level" is lower than my total T, so I'm not sure that I should. My super low Free T bothers me, and is probably the root of my remaining symptoms.

Any help you guys can pass my way would sure be appreciated.

Thanks for taking the time to read this long ass post...

[JanSz]

Look for ostheopatic doctor.
http://www.osteopathic.org/directory.cfm
Get the best you can status on your adrenals and thyroid.

When time comes for T supplementation (with your insurance paying) I would start (and probably end) on 2 x 5mg Androgel. Trying smaller amounts just prolongs agony. Spread the gell all over the body but avoid scrotal area. Time permitting put one pocket in the morning the other one few hours latter. Do not worry about gel absorption if some days you do not want take a shower.

Add DHT and Progesterone to your tests.
Hematocrit when on Androgel.

[marianco]

Originally Posted by Rangeball

Hello all.

I posted here quite a while back for awhile, and still lurk. I'm a 42 year old male, and I was diagnosed hypothyroid over a year ago, and have been slowly working my way up the armour doseage scale. My doc is a general surgeon and GP, and a family friend. He was out of his comfort zone on the armour and bigger doses I kept requesting since my TSH all but dissapeared but my FT3 and 4 levels were still in the tank. I have a 2.5 grain script for armour from him, and am using thyroid-s to supplement and increasing on my own with help from others who've gone before me. I focused on Thyroid as swale said it can mimic hypogonadism and should be treated first. I found I needed to start isocort as I wasn't tolerating the armour at higher doses, and have been using it for a few weeks now with good results.

In denying my last request for an armour bump, my doc said other things could cause the symptoms I am experiencing, primarily low libido, weaker erections, brain fog, poor memory, low energy and down mood. So I asked to run a bunch of tests, and he agreed. Results were as follows-

Vitamin D Panel*
Vit D, 1,25-Dihydroxy- 47 15-60 range
Vit D, 25-OH, total- 24 20-100 range
Vit D, 25-OH, D3 24
Vit D, 25-OH, D2 <4

*Measurement of 25-OHD2 is an indicator of compliance with supplements. Levels >4 suggest compliance. 25-OHD3 indicates endogenous production. Therapy should be based on measurement of Total 25-OHD, with levels <20 suggesting Vitamin D deficiency and levels between 20 and 30 suggesting a possible need for supplementation.

I am supplementing Vitamin D3 at 4000 IU daily.

Vitamin B-12 469 200-1100 range

From what I've read, while in range it's still low. I supplement sublingual B12 tabs daily.

Estradiol (ultra sensitive) 20 10-50 range. This one suprised me. I was sure it would be eleveated. According to Swale I'm right in the sweet spot, iirc.

Cortisol- 7 5-21 range for males sample taken 8-10 am.

While in range, still low, just like I suspected. I plan to continue the isocort to allow my adrenals to heal since they've obviously been picking up the thyroid's slack.

SHBG- 44 8-46 range. No wonder.

Total Testosterone- 436 250-1100 Much lower than it should be. I'm 42

Free Testosterone- 47.7 35-155 Hmmmm...
% Free Testosterone- 1.09 L 1.1-2.8 range. Not good.

DHEA-S- 257 43-345 range. From what I've read this should be higher. I supplement it now daily with 50 mg DHEA, will switch to 7-keto to avoid estrogen conversion soon.

FSH- 5.6 1.6-8 range
LH- 4.8 1.5-9.3 range Looks like the boys are getting called on, they're just not up to it?

Prolactin- 6.1 2.0-18 range. I've read where this is high for males with prostate cancer, but can't find much for normal males.

Sorry for the long post, but I meet with my doc next thursday to discuss TRT. I've emailed him my thoughts and Swale's protocol. I have drug insurance that would cover androgel, and if transdermal work will eventually compound my own to lower my cost. Pellet therapy sounds interesting, but I don't think my doc does it.

Ahead of my appointment I'm trying to brush up to be prepared. With my results, do I have Primary, secondary or central hypogonadism? I've printed out charts that show the symptoms of low T, I have most of them. I wanted to print out the graph that shows average T levels by age, but that red line that says "recommended treatment level" is lower than my total T, so I'm not sure that I should. My super low Free T bothers me, and is probably the root of my remaining symptoms.

Any help you guys can pass my way would sure be appreciated.

Thanks for taking the time to read this long ass post...

Low free testosterone means there is relatively high SHBG, which means there is a problem involving one or a combination of thyroid hormone, progesterone, testosterone, DHEA, insulin, or growth hormone, and other androgens.

SHBG is raised by high thyroid, high estradiol, high progesterone, low testosterone, low DHEA, low insulin, or low growth hormone, or a combination.

[Rangeball]

Thanks.

I did plan to test DHT and I guess now progesterone before I started TRT if that is the way my doc is headed.

Marianco, if a patient presented to you with the listed symptoms and labs, what would be your approach or recommendation? If there is a fixable cause that would prevent me from being tied to TRT, I'm all ears, and trying to be informed ahead of my visit this week.

[marianco]

Originally Posted by Rangeball

Thanks.

I did plan to test DHT and I guess now progesterone before I started TRT if that is the way my doc is headed.

Marianco, if a patient presented to you with the listed symptoms and labs, what would be your approach or recommendation? If there is a fixable cause that would prevent me from being tied to TRT, I'm all ears, and trying to be informed ahead of my visit this week.

The top dose for Armour Thyroid is 300 mg a day (about 5 grain). If a person is still having problems at this dose, then it is highly important to evaluate for other causes of his/her symptoms. For example, are there other contributing factors such as an inability to activate T4 to T3 due to problems with the deiodinase enzymes? Is adrenal fatigue significant so that it interferes with the activation of thyroid hormone? It is important to get follow up evaluations and have good parameters to measure because a person should avoid hyperthyroidism since it risks atrial fibrillation and congestive heart failure, among other effects.

IsoCort may be too mild for many people with adrenal fatigue - and costly when very high doses are used. Appropriate doses of Hydrocortisone, Medrol, Prednisolone, or even Prednisone may be necessary to use instead.

Ideally (though the world is not ideal), treatment of hypothyroidism and adrenal fatigue is done before testosterone replacement (particularly in a person with testosterone over 400 ng/dl). When thyroid hormone and adrenal hormone activities are optimized, sex drive, fatigue, depression, and other problems can improve significantly even with low testosterone levels. What a physician does will, of course, depend on a person's condition and situation. The treatment has to be customized to the person.

[Rangeball]

Thanks so much for you input. It really means alot.

Originally Posted by marianco

The top dose for Armour Thyroid is 300 mg a day (about 5 grain). If a person is still having problems at this dose, then it is highly important to evaluate for other causes of his/her symptoms. For example, are there other contributing factors such as an inability to activate T4 to T3 due to problems with the deiodinase enzymes? Is adrenal fatigue significant so that it interferes with the activation of thyroid hormone? It is important to get follow up evaluations and have good parameters to measure because a person should avoid hyperthyroidism since it risks atrial fibrillation and congestive heart failure, among other effects.

I've been self monitoring for hyper-thyroid, and whenever I feel it is a possibility I back down on my armour. Since starting armour (at 1 grain with a re-test every 6 weeks and a .5 grain bump up to 3 grains then back down to 2.5 because my TSH bottomed out) I've had brief moments where my symptoms resolved, but each time returned as endogenous production slowed in response to the armour. So you feel I should see if I can get up to 5 grains if needed and not pursue TRT until I've done so if symptoms are not resolved?

IsoCort may be too mild for many people with adrenal fatigue - and costly when very high doses are used. Appropriate doses of Hydrocortisone, Medrol, Prednisolone, or even Prednisone may be necessary to use instead.

I've been trying to locate hydrocortisone. I can't convince my doc to go any higher with the armour (I'm doing so myself and am up to 4 grains) so I'm doubtful he'll give me a script fo the hydrocortisone. I've been upping isocort, but it's not really helping and I'm concerned doing so because of the company's reluctance to disclose it's ingredients and amounts (I understand it's not standardized).

Ideally (though the world is not ideal), treatment of hypothyroidism and adrenal fatigue is done before testosterone replacement (particularly in a person with testosterone over 400 ng/dl). When thyroid hormone and adrenal hormone activities are optimized, sex drive, fatigue, depression, and other problems can improve significantly even with low testosterone levels. What a physician does will, of course, depend on a person's condition and situation. The treatment has to be customized to the person.

Thanks. I'll see what my doc has to say, then go from there.

[Rangeball]

Marianco, as I stated I am trying to find hydrocortisone to replace the isocort. This may prove to be a long, drawn out process.

In the interim, what are your thoughts on using nettle root, dim or saw palmetto to bind up some SHBG and possibly free up some testosterone?

If not these, would you recommend anything else?

[Rangeball]

Are there any drugs that effectively reduce SHBG?

[Rangeball]

One more question then I promise to wait until you respond

What are your thoughts on my prolactin levels? I've had some tell me they are elevated and should be closer to 2, but the only info I can find to back that up is in men with prostate cancer history.

[marianco]

Originally Posted by Rangeball

I've been self monitoring for hyper-thyroid, and whenever I feel it is a possibility I back down on my armour. Since starting armour (at 1 grain with a re-test every 6 weeks and a .5 grain bump up to 3 grains then back down to 2.5 because my TSH bottomed out) I've had brief moments where my symptoms resolved, but each time returned as endogenous production slowed in response to the armour. So you feel I should see if I can get up to 5 grains if needed and not pursue TRT until I've done so if symptoms are not resolved?

I've been trying to locate hydrocortisone. I can't convince my doc to go any higher with the armour (I'm doing so myself and am up to 4 grains) so I'm doubtful he'll give me a script fo the hydrocortisone. I've been upping isocort, but it's not really helping and I'm concerned doing so because of the company's reluctance to disclose it's ingredients and amounts (I understand it's not standardized).

If the brain is unable to measure Free T3 correctly and thus produces too little TSH when Free T3 is low (e.g. due to aging, brain injury, etc.), then TSH becomes a less important measure. Rather, it is more important to measure Free T3 and Free T4 to determine the course of treatment, in addition to the person's signs and symptoms.

IsoCort is standardized. However, if the company advertises that it contains hydrocortisone, then it would get into trouble with the FDA - which would then benefit no one.

[marianco]

Originally Posted by Rangeball

Marianco, as I stated I am trying to find hydrocortisone to replace the isocort. This may prove to be a long, drawn out process.

In the interim, what are your thoughts on using nettle root, dim or saw palmetto to bind up some SHBG and possibly free up some testosterone?

If not these, would you recommend anything else?

Most physicians are more familiar with Prednisone, which is approximately 4 times more potent than Hydrocortisone.

Free Testosterone does not reflect testosterone's activity. Total testosterone is the best measure, in my opinion. Bioavailable testosterone is the second best measure. Free Testosterone primarily serves as an indicator that there is something wrong with one or more hormones including: insulin, thyroid, estrogen, progesterone, testosterone, DHEA, growth hormone.

SHBG serves a purpose. When bound to testosterone or estrogen, it can bind to SHBG receptor and transmit signals to cells. SHBG prolongs the life of testosterone - helping maintain a higher total testosterone level.

[marianco]

Originally Posted by Rangeball

One more question then I promise to wait until you respond

What are your thoughts on my prolactin levels? I've had some tell me they are elevated and should be closer to 2, but the only info I can find to back that up is in men with prostate cancer history.

Based in the current knowledge I have, when Prolactin is within the reference range for men, then the level is fine.

Prolactin is elevated under certain circumstances including:
1. When dopamine levels are low - such as after an orgasm
2. When there is a prolactin-secreting pituitary tumor
3. When taking a medication (such as an antipsychotic) which blocks dopamine

[Rangeball]

Originally Posted by marianco

Free Testosterone does not reflect testosterone's activity. Total testosterone is the best measure, in my opinion. Bioavailable testosterone is the second best measure. Free Testosterone primarily serves as an indicator that there is something wrong with one or more hormones including: insulin, thyroid, estrogen, progesterone, testosterone, DHEA, growth hormone.

SHBG serves a purpose. When bound to testosterone or estrogen, it can bind to SHBG receptor and transmit signals to cells. SHBG prolongs the life of testosterone - helping maintain a higher total testosterone level.

I'm confused. I thought free or bioavailable is the only form of active test the body can use. I thought test bound to SHBG was basically inactive.

Are you recommending against trying a product that binds to SHBG and therefore frees up more test? I was looking at the Protein Factory's product "Unleashed" that contains the active extracts from Avena Sativa and Nettle root, and the reviews are overwhelmingly positive that it restores morning erections and enhances mood, outlook and strength levels.

[Rangeball]

Originally Posted by marianco

IsoCort is standardized. However, if the company advertises that it contains hydrocortisone, then it would get into trouble with the FDA - which would then benefit no one.

So the 2.5mg of hydrocortisone per isocort tab is correct? If 20mg (8 tabs) isn't doing it, how high can one safely go to allow higher doses of armour?

[Rangeball]

Bump for marianco.