# Here is my Dilemma (throid or testosterone)?



## sctwest (Mar 25, 2012)

OK, so my thyroid is off
TSH-2.62 (.34-5.00)
T4-7.5 (6.0-12.0)
FREE T4-0.8 (0.6-1.6)
TOTAL T3-123 (87-178)

And my testosterone is a little low
testosterone-299 (175-781)
This was taken in the morning when it should be its highest.

I found out this is low after finding a chart on testosterone levels by age group which says mine should be 597.

*How do you know which one should be addressed first?*

My doctor said my thyroid and testosterone are fine but after doing some research I found they are both a little low.

Does anyone have any advice for me?

Thanks


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## bigfoot (May 13, 2011)

You are absolutely correct in your research, and it's probably high time to find a doc who understands this hormone and endocrine stuff in more detail. A Total Testosterone level of 299 is *NOT* in all likelihood, "fine," as your doctor said. There are some folks walking around with a level of 299 who might be okay, but you presented yourself to your doc, obviously have complaints, and these labs (thyroid and testosterone) are off.

Do not pass go, do not collect $200. You need to ideally find out _why_ your testosterone is low in the first place, before starting any sort of treatment. And you also want to get your thyroid squared away first before starting testosterone treatment. The two play off each other and one being out of whack can mess up the other. Symptoms from testosterone and thyroid issues can sometimes appear the same. Fatigue, low libido, low energy, brain fog, anxiety, depression, weight gain, etc. and the list goes on. Look into reading "The Testosterone Syndrome" by Dr. Shippen (a little dated, but still good), and "Stop the Thyroid Madness" (STTM), which overly simplifies things and pushes Armour, but is also still good.

Get more comprehensive hormone labs drawn ASAP. You need all of these:
- Total Testosterone
- Free Testosterone
- SHBG
- Estradiol
- TSH
- Free T4
- Free T3
- TPO Ab
- Thyroglobulin Ab
- 24-Hour Cortisol (Urine or Saliva)

And look into getting these done, too:
- Liver panel
- Iron
- CMP & CBC
- Vitamin D-25
- Vitamin B-12
- Celiac disease
- Gluten Sensitivity (typically saliva, not the same as full-blown Celiac)
- Prolactin

I have been going through all of this stuff for the last five years, and while it's not easy, there is definitely a right way and a wrong way to go about it. The labs above will give you a baseline of where to start and save you a lot of frustrations and headaches down the road. Same goes for investigating the "why" before initiating any sort of treatment. My humble opinion? You might need thyroid meds and testosterone replacement. But until you have the test results, and a good doc to interpret them, it's really impossible to know exactly where to start. There could be something else in the background influencing all of this.

Testosterone hormone-replacement will involve a handful of common choices. Which treatment you choose and works for you will vary. If/when you do start hormone replacement, docs typically begin at around 5-7.5mg a day, which is what your body makes naturally. Treatment will shrink the testes and your body will slow/stop production with this external T applied. That's why it's important to get a full replacement dose for your body, then re-test the levels along the way, adjusting up or down if necessary.

- Topical Gels (Androgel, Testim)
- Patches (Androderm, etc.)
- Injections (Testosterone Cypionate)

Each T. treatment choice has its pro's/con's. The Gels are easy to apply, but can transfer to spouse & kids if not careful, and are messy. Patches are a little simpler, and give a nice 24-hour output, but adhesives can irritate the skin. Injections are usually described as every two-weeks or once-monthly, done in the doc's office, but *really* you'd want to do it at home weekly to avoid big time hormone crashes towards the end of the cycles. The injections are the gold-standard, but you really need someone well-versed in hormones to guide you.

On to the thyroid... again, gonna need those more detailed labs. Total T4 and Total T3 are pretty much worthless. The TSH gives a rough idea of things, but the Free T3 and Free T4 are what to dose potential treatment on. The antibody tests (TPO and Thyroglobulin) will give an idea of whether you are dealing with Hashimoto's, or just straight hypothyroidism. Despite what the docs say, they are *not* one in the same. Hashimoto's is an autoimmune attack that eventually leads to hypothyroidism (after years and years), while hypothyroidism is just your body not producing enough thyroid hormone.

Thyroid medications are going to be either synthetic or natural, in either T4-only, T3-only, or combo T4+T3. Always go for brand-name if you can, with no substitutions by the pharmacy. Generics are okay, but can vary in potency, and which manufacturer supplies the pharmacy each month. Synthroid, Levoxyl (currently recalled), etc. are brand-name T4-only meds.

If you are a poor converter of T4->T3, then you might want to look into Armour or Nature-throid down the road, which is natural and porcine-based, and has a fixed ratio of T4/T3 in it. Or you can combine synthetic levothyroxine (T4) with something like a small amount of Cytomel (T3). Finding a doc who will RX Armour-type products or Cytomel is going to take a little research, same goes for one who doesn't dose solely by TSH level.

Most docs, urologists, and endocrinologists will go by lab numbers only for thyroid and testosterone, and will throw T4-only (levothyroxine) and a testosterone gel at you, and send you on your way out the door. Bad idea. You need to find a skilled D.O., an out-of-the-box MD, naturopath, or anti-aging doc. Or you might get lucky and find an astute endo or urologist in your area.

Hope I didn't throw too much out there, apologies for some of the rambling, but if you have any questions please ask. I know there are a few of us floating around on the boards here who are dealing with thyroid AND testosterone issues.


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## joplin1975 (Jul 21, 2011)

bigfoot said:


> - Topical Gels (Androgel, Testim)
> - Patches (Androderm, etc.)
> - Injections (Testosterone Cypionate)


Ditto everything BigFoot said and adding intramusclar, dissolvable pellets are out there too and have been one heck of a blessing for my husband (yes, we are a hormonally challenged family  ). They don't work for some folks, but for him it seems to be great.

His lastest blood draw had him in the 280s, I think, and he was feeling pretty miserable. So, I, too, don't think you are "fine."


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## Andros (Aug 26, 2009)

sctwest said:


> OK, so my thyroid is off
> TSH-2.62 (.34-5.00)
> T4-7.5 (6.0-12.0)
> FREE T4-0.8 (0.6-1.6)
> ...


Boy, that doctor is discouraging. Bigfoot to the rescue. He knows his stuff.

Usually (but not always); thyroid causes low Testosterone, Vitamin D and Ferritin.


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## Andros (Aug 26, 2009)

bigfoot said:


> You are absolutely correct in your research, and it's probably high time to find a doc who understands this hormone and endocrine stuff in more detail. A Total Testosterone level of 299 is *NOT* in all likelihood, "fine," as your doctor said. There are some folks walking around with a level of 299 who might be okay, but you presented yourself to your doc, obviously have complaints, and these labs (thyroid and testosterone) are off.
> 
> Do not pass go, do not collect $200. You need to ideally find out _why_ your testosterone is low in the first place, before starting any sort of treatment. And you also want to get your thyroid squared away first before starting testosterone treatment. The two play off each other and one being out of whack can mess up the other. Symptoms from testosterone and thyroid issues can sometimes appear the same. Fatigue, low libido, low energy, brain fog, anxiety, depression, weight gain, etc. and the list goes on. Look into reading "The Testosterone Syndrome" by Dr. Shippen (a little dated, but still good), and "Stop the Thyroid Madness" (STTM), which overly simplifies things and pushes Armour, but is also still good.
> 
> ...


Thank you, dear friend!


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## bigfoot (May 13, 2011)

Maybe when I start feeling better I'll hit the community college for a few courses, then go get a job at a doctor's office as a medical assistant or something. Hah! Might as well get paid for it. :tongue0013:


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## sctwest (Mar 25, 2012)

I don't know if this matters but I used to take finistrate (propecia) for a few years but I have been off of it for 5 or 6 years now. But that is when I started noticing my fatigue and moodiness. Other blood levels that caught my eye were:

b12 - 462 (180-914) I read that under 500 could be low.
ferritin - 139 (24-336)
iron - 116 (45-182)
vit d - 54 (20-80) vit d 25 oh
colesterol - 233 (0-200)
triglyceride - 199 (0-150)
hdl - 43 (>39)
chol/hdl - 5.4 (<5)
ldl - 150 (40-130)
non hdl chol - 190.0 (no range)
fsh - 6 (1-19)
neutrophil - 50.8 (54.0-62.0)
lymphocyte - 36.5 (25.0-33.0)


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## bigfoot (May 13, 2011)

The elevated cholesterol (esp. triglycerides) are pretty typical with autoimmune / thyroid issues. I think there can be some lipid trouble from low testosterone, too, IIRC. Your lymphocytes look a little elevated above the upper range, but I don't know enough about that stuff to comment on whether it is really significant or not.

http://en.wikipedia.org/wiki/Lymphocytosis

I think in general we are pretty good at noticing when something changes our bodies. A quick Google search yielded lots of articles on Propecia issues and/or side-effects. What would be interesting to know is if there's any interactions with endocrine system (esp. thyroid and testosterone) by taking such a drug. If you look through the pamphlet for Propecia, you might find something. Docs don't usually remember it all, and drug companies aren't always in a rush to disclose info. on the front page in bold text.

Edit: What just caught my eye was the wording on this NIH link a couple of paragraphs down from the top... (underline my emphasis)

"Finasteride blocks the action of an enzyme called 5-alpha-reductase. This enzyme changes testosterone to another hormone that causes the prostate to grow or hair loss in males. It will increase testosterone levels in the body, which decreases prostate size and increases hair growth on the scalp. The effect of finasteride on the prostate and scalp will only last as long as the medicine is taken. When it is stopped, the prostate begins to grow again and the hair will be lost."

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0010302/?report=details#side_effects


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## Prsartist (May 30, 2013)

I've hot a couple comments, don't know much about thyroid, but why is the OP's thyroid
Considered low? (I've just learned I have high levels of the antibodies) but the other #'s fall in the "normal" range like his)

I also have low testosterone issues, and have become a bit of an expert on this issue.

You didnt state your age, but unless your a sick 95 y.o. 
Your Testosterone level is TOO LOW!
I was at 288 before treatment and I was miserable! Had all the classic low T symptoms
Plus bad muscle aches!

Problem for you will be finding a Dr to recognize the problem!
I had at least 10 different Dr's look at my labs (288 shows as in the "normal" range)
And none of them saw this as a problem! THEY WERE ALL WRONG!

Best bet would be to try an anti-aging clinic?
They saw the problem instantly!


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## sctwest (Mar 25, 2012)

I am 43, male, 5'10, 175lbs.

Went to a new doc and he said it looked a little low but he didn't say anything about treating it. He had me do a new blood test, hopefully my testosteron is still at 299.


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## Andros (Aug 26, 2009)

bigfoot said:


> Maybe when I start feeling better I'll hit the community college for a few courses, then go get a job at a doctor's office as a medical assistant or something. Hah! Might as well get paid for it. :tongue0013:


It is never too late for a career change!! You "are" awesome w/this medical stuff.


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## bigfoot (May 13, 2011)

sctwest said:


> I am 43, male, 5'10, 175lbs.
> 
> Went to a new doc and he said it looked a little low but he didn't say anything about treating it. He had me do a new blood test, hopefully my testosteron is still at 299.


Ugh. Not good. As previously mentioned, that is on the waaay low end. Enough to qualify as "normal" on a lab test? Yes. Enough for your body and mind to function properly, especially at age 43? Nope.

Just gotta keep pushing for answers, pieces of the puzzle, and likely, treatment.


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## Prsartist (May 30, 2013)

sctwest said:


> I am 43, male, 5'10, 175lbs.
> 
> Went to a new doc and he said it looked a little low but he didn't say anything about treating it. He had me do a new blood test, hopefully my testosteron is still at 299.


Hopefully it's NOT! Why would you want that ??


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