# Hypothyroidism & Hypogonadism



## Petrucci914 (Mar 14, 2012)

Hello Everyone,

I'm a 26 year old Male. I've been suffering for about 10 years now with extreme fatigue, somnolence, depression, anxiety, weight & temperature irregularities, trouble waking up in the morning.......the list goes on. I've seen dozens of GPs, sleep doctors, psychiatrists and been on just about every antidepressant and stimulant available. Most did nothing and some made my symptoms worse. I finally started asking doctors to test specific things and lo and behold we find something. This past July I was diagnosed with Idiopathic Hypogonadatrophic Hypothyroidism. (I made them test my Free T4 and Free T3, and Total Testosterone)

I was started at 75mcg Synthroid & 2 Pumps of Androgel. I am currently on 88mcg Synthroid every day, half 1 day a week, and 4 pumps of Androgel. Needless to say none of symptoms have improved. I have to force my doctor to do a blood test ever 6-8 weeks, and then she just changes something (stabs in the dark), doesn't answer my questions, and moves me on my way. I would think being treated for 8 months I would have something to show for it. Here are my results from the beginning:

6/2011
Total Testosterone - 223 ng/dL

7/2011
Free Testosterone - 70 pg/mL
Total Testosterone - 298 ng/dL
Free T4 - 0.7 ng/dL
FSH - 2.0 munit/mL
LH - 1.4 munit/mL
Prolactin - 7.4 ng/mL
SHBG - 18 nmol/L
TSH - 2.349 uIU/mL

8/2011
Free T4 - 0.6 ng/dL
Total Testosterone - 285.9 ng/dL
TSH - 1.432 uIU/mL

10/2011
Free T4 - .5 ng/dL
Total Testosterone - 199.3 ng/dL

12/2011
TSH - .087
Free T4 - .75
Total Testosterone - 270

2/2012
ACTH - 26 pg/mL
Cortisol Pre Stimulation - 16.9 ug/dl
Cortisol Post Stimulation - 29 ug/dl
TSH - .062
Free T4 - .9
Total Testosterone - 177.9

So it looks like my T4 was improved but now my TSH is really low but my doctor said, "I don't really trust what you pituitary is saying." I had an MRI and I have no pituitary tumors. It also doesn't look like the Androgel is helping at all, and neither did the Androderm patch.

I'd like to try Armour Thyroid but my Endo won't prescribe it because she said it's not predictable. I'd also like to try Clomiphene Citrate to increase my testosterone and increase my fertility but she didn't even want to discuss it.

There are so few Endocrinologists and so few good doctors. I'm close to giving up.


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## Octavia (Aug 1, 2011)

Hi, and welcome to these boards. This really stinks for you. (You know that already!)

By any chance, do you have the ranges that go along with your lab results? Are you getting them done at the same place each time? (It's okay if you're not...it's just that the ranges will likely be different.)

At a glance (and without seeing the normal ranges for your lab), your Free T4 seems very low for the duration of your labwork...and it doesn't seem to jive with your low TSH...but I'm not a lab test expert. Others here will respond with greater insights into the lab results.

It does sound to me like your doctor is shooting in the dark. I would imagine that your diagnosis is not one she sees very frequently. I wonder if you might feel comfortable asking her, in the most respectful way possible, if she could refer you to an endocrinologist who might work with more patients with similar issues. I imagine you are both a little frustrated with the situation, so she may welcome the opportunity to hook you up with someone else.


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## Andros (Aug 26, 2009)

Petrucci914 said:


> Hello Everyone,
> 
> I'm a 26 year old Male. I've been suffering for about 10 years now with extreme fatigue, somnolence, depression, anxiety, weight & temperature irregularities, trouble waking up in the morning.......the list goes on. I've seen dozens of GPs, sleep doctors, psychiatrists and been on just about every antidepressant and stimulant available. Most did nothing and some made my symptoms worse. I finally started asking doctors to test specific things and lo and behold we find something. This past July I was diagnosed with Idiopathic Hypogonadatrophic Hypothyroidism. (I made them test my Free T4 and Free T3, and Total Testosterone)
> 
> ...


Welcome!










At no time has your doc run the FREE T3 which is your active hormone unbound available for cellular uptake.

I am of the humble opinion that you need a new doctor and fast.

FREE T3 must be run. Also, in the future, we do need ranges w/results as different labs use differerent ranges.

Just to get up to date, if you would please do that for the 2/2012 lab results, we will all appreciate it.

Please read why FREE T3 is an essential test for evaluation.

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.drlam.com/articles/hypothyroidism.asp?page=2#diagnosis: standard laboratory test

Dr. Woliner
http://www.thyroid-info.com/articles/freet3woliner.htm

understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid

Free T3 etc. 
http://www.thyroid-info.com/articles/freet3woliner.htm

Also, your doctor has not done any antibody tests?

You don't need an endo really; you just need a doctor who is willing to run the appropriate tests and cares about your well being. A GP can do this or a PCP, Internal Med etc..

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

I am so sorry that your case has been so mismanaged. I hope you find the help you seek here. We also have quite a few men so I am sure they will be along.


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## Avakb (Mar 15, 2012)

You also haven't mentioned which labs were done while you were taking medication. Have you asked to have your TRH checked? This may be able to rule out tertiary hypothyroidism, in which the hypothalamus does not stimulate the pituitary to produce enough TSH. I would say though that based on your mildly elevated TSH from June and July, that this is probably not the case.
Your free T4 levels do not appear to be increasing with medication. I am new to all of this but it does appear to be very odd. Optimally, your Free T4 levels would be in the upper third of the lab range, typically at least 1.5-1.8
I agree that a referral to an endocrinologist is the best decision.


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## Petrucci914 (Mar 14, 2012)

Hi Everyone,

Thank you for the responses. I'll get you the ranges tonight from the 2/2012 labs.

I thought I had my Free T3 done months ago but according to my results, I don't see it. They said my Free T4 was slightly low and that's why they started me on Synthroid. Since then my Free T4 has increased .1 or .2 and my TSH has gone down dramatically. I understand that some doctors make prescriptions totally ignoring TSH but I don't know if that is good or bad.

Years ago I encouraged my doctors to test my Thyroid and they always just tested TSH, said it was fine, and then we totally ruled it out as being a problem. It seems that doctors' knowledge of Endocrinology is lacking and Endocrinologists are so few and far between.

I may just stop my Synthroid and Androgel since neither of them seem to be making a difference.


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## jmill (Mar 23, 2010)

Androgel won't work on everyone. About 20% of the people who try it don't absorb it well enough to make a significant difference. I tried it for several months and gave up. It wasn't working and it was a real pain to work with everyday. Talk to your doctor about Testosterone Cypionate injections. I switched and give myself the injections. It's really easy and it works very well. I uped my shots from every two weeks to weekly and reduced the dose. No swings in how I feel and it only takes five minutes a week to do it. I had a lot of the problems you're having. Hang in there, it will get better. It's just a very slow process even after you find a good doctor. It's a lot of trial and error to get the right meds.


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## Petrucci914 (Mar 14, 2012)

Here are the 2/2012 Results and References

TSH - .062 (Reference .34-5.6 uIU/ml)
Free T4 - .9 (Reference .5-1.5 ng/dl)
Total Testosterone - 177.9 (Reference 175-781 ng/dl)

In terms of those injections, where do you inject them and how deep do you have to go? Sounds a little intimidating giving myself injections. Are these ready-to-go syringes you get from the pharmacy?

Thanks!


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## jmill (Mar 23, 2010)

Petrucci914 said:


> Here are the 2/2012 Results and References
> 
> TSH - .062 (Reference .34-5.6 uIU/ml)
> Free T4 - .9 (Reference .5-1.5 ng/dl)
> ...


The injections are given in the leg. The syringes are seperate from the Test Cypionate and you have to fill them yourself. The doctor showed me how and the first time I did it under his supervision. It's really easy. I'm not a medical person and never did it before. After doing it once it's no big deal. My testosteron levels went up pretty quick and I felt a lot better. Still have the thyroid to deal with but we're working on that too. I'm WAY better than I was even a couple of months ago now that I'm on Synthroid and Cytomel. Still playing with the dosages on those meds.


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## Petrucci914 (Mar 14, 2012)

jmill said:
 

> The injections are given in the leg. The syringes are seperate from the Test Cypionate and you have to fill them yourself. The doctor showed me how and the first time I did it under his supervision. It's really easy. I'm not a medical person and never did it before. After doing it once it's no big deal. My testosteron levels went up pretty quick and I felt a lot better. Still have the thyroid to deal with but we're working on that too. I'm WAY better than I was even a couple of months ago now that I'm on Synthroid and Cytomel. Still playing with the dosages on those meds.


Did you ever look into Clomiphene Citrate?

http://www.ncbi.nlm.nih.gov/pubmed/12904801

http://www.ncbi.nlm.nih.gov/pubmed/16422830

Seems like the easiest and cheapest method to increasing Testosterone and maintaining fertility.


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## Andros (Aug 26, 2009)

Avakb said:


> You also haven't mentioned which labs were done while you were taking medication. Have you asked to have your TRH checked? This may be able to rule out tertiary hypothyroidism, in which the hypothalamus does not stimulate the pituitary to produce enough TSH. I would say though that based on your mildly elevated TSH from June and July, that this is probably not the case.
> Your free T4 levels do not appear to be increasing with medication. I am new to all of this but it does appear to be very odd. Optimally, your Free T4 levels would be in the upper third of the lab range, typically at least 1.5-1.8
> I agree that a referral to an endocrinologist is the best decision.


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## miguel (Jul 18, 2011)

My libido decreases with dose changes and increases after 1 month of stay in a dose. My testosterone levels in November was 358 ng / dl (175-781), my endo said it was normal but I would like it to be higher. I heard that the appropriate level of thyroid hormone could correct low T, but it requires to spend a few months in a ''optimal dose'' I hope to confirm this in the future.


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## Avakb (Mar 15, 2012)

I also wanted to mention that you should get your estrogen levels checked. High estrogen levels can throw off your testosterone, even if it were in normal ranges. I highly recommend the book "Why do I still have hypothyroid symptoms" by Dr Datis Kharrazian. I came across some of your specific issues when I was perusing it today. Admittedly, I did not absorb enough of the information to relay it to you here. 
Also, here is the list of top thyroid docs on Mary Shomon's website. Many are holistic internal medical doctors.
http://thyroid.about.com/cs/doctors/a/topdocs.htm


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## Marathon Man (Aug 31, 2011)

If you begin a testosterone cypionate plan you will need to incorporate HCG in order to remain fertile.


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## miguel (Jul 18, 2011)

Vitamin D and Testosterone:
http://www.ncbi.nlm.nih.gov/pubmed/21154195


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## Petrucci914 (Mar 14, 2012)

Well, I saw a new Endocrinologist last week. She looked at all my results and said that if she were to have seen me earlier she wouldn't have diagnosed me with Hypogonadism because my Free Testosterone was in the normal range, even though my total testosterone was low. She agreed, nonetheless, to have me try testosterone injections to see if I feel any better. We'll see how that goes. She is keeping my Syntroid roughly the same (88mcg daily instead of 88mcg daily except one day take half).

I wanted to try Clomiphene instead of the injections and she agreed to look into it but after she looked into it she said she didn't want to venture down that road because it isn't documented by the Endocrinology Society.

I really think in order for me to get any answers I need to get an Endocrinologist, Psychiatrist, ENT, and Sleep Doctor in the same room and duke it out.


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