Low testosterone with thyroid antibodies

[Val-55]

I’m posting to ask advice please . My friend has a 26 year old son who for the last 2 years has been treated for low testosterone. He is not making progress and feels quite ill using the rub in gel . I had a look at his recent blood tests .His TSH was 1.75 range to 6 .T4 was 8 and T3 was 3.54 range to 6.5 ... antibodies were up to 35 his are 75 so over sorry cant remember all ranges which I know are important ,,, but I’ve had enough blood tests to see it was all low . I know Dr won’t look at TSH at that level but linked to all the testosterone problems could the thyroid problem be causing it ? I would appreciate your thoughts .Thankyou

[greygoose]

Looking at those results, two questions come to mind: a) has he had his cholesterol tested? Is it high? b) if his cholesterol is high, is he taking statins? That's three questions, but never mind.

[Val-55 in reply to greygoose]

No he is not taking statins ,, but I will see if he has had a cholesterol test as it seems there is a link . He is very health focused , gym and heathy food .

[greygoose in reply to Val-55]

Cholesterol levels are nothing to do with whether you look after your health or not, and very little to do with your diet. It's more than likely low T3 that causes high cholesterol, which is why I asked. And, taking statins reduces testosterone. And his FT3 is low. But, then again, if your thyroid hormones are out of kilter, that is going to have a knock-on effect on all your other hormones.

So, his FT3 is low in range, and his FT4 looks to be below range, but his TSH is about mid-range. Which looks like Central hypo. Central hypo is when the problem likes with the pituitary (Secondary hypo) or the hypothalamus (Tertiary hypo) rather than the thyroid itself (Primary hypo). And, if it's the pituitary that is the problem, that would account for the low testosterone, because it would also affect the adrenals. So, that's the direction he needs to go in.

Doctors believe that Central hypo is rare, so they never look for it. Most GPs have never even heard of it. So, he would need to do his research to know what he was talking about, to convince his GP to refer him to an endo, who might possibly know.

[Val-55 in reply to greygoose]

Thankyou very much for you reply . I think he said his adrenals were wrong !!, He has an appointment with a specialist in men’s health / testosterone . He is pinning his hopes on this , his testimonials seem encouraging ,,, has to be better than a gp ..basic endocrinologist!

[greygoose in reply to Val-55]

Should be, yes. But, he should still do his homework, so that he can understand all that is said, and ask pertinent questions. Testosterone is made by the adrenals, but they are controlled by the pituitary, as is the thyroid.

[SilverAvocado in reply to Val-55]

Val-55, the pathway to get diagnosed with Central Hypothyroid is quite unclear, as the guidelines aren't good. There are about 7 different areas of hormone that the pituitary has a hand in and that can be impacted when it goes wrong. I believe this is usually a benign tumour, and the hormones it affects depend on its location inside the pituitary.

Let's see how many of these I can remember:

1)Prolactin and hormones to do with lactation and pregnancy (its never occurred to me to ask if men can have these impacted, too. I've read that 40% of pituitary tumours cause off the scale high prolactin)

2)Sex hormones

3)Growth hormone

4)Liver

5)Skin pigmentation

6)Thyroid

I may have missed one or two.

A forum regular who had to diagnose herself with Central Hypothyroid told me that she learned about these things by buying endocrinology text books herself, and working out what the markers could be. She turned out to have high prolactin, several times the top of the range, and eventually was able to get an MRI to show the tumour.

[purple64 in reply to SilverAvocado]

My son had high prolactin which was discovered when having tests for Klinefelter syndome

[SlowDragon Administrator]

For full Thyroid evaluation he needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

His antibodies seem to be above range and FT4 extremely low

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Has he had vitamin D tested?

[Jazzw]

Looking at those levels (although more details about the laboratory reference ranges would help) it looks like he might potentially have a pituitary problem.

What tests have been done to establish why his testosterone is low??

[galathea]

Not linked to IGSF1 gene mutation is it? mcgill.ca/channels/news/new...

[Val-55 in reply to galathea]

That’s interesting , he is seeing a testosterone specialist in a couple weeks will send this link to him .thankyou

[radd in reply to galathea]

Wow. This is very interesting galathea.

Sadly dated 2012 and still virtually unknown, and another hypo condition that won’t be exposed by the inadequate golden standard TSH test.

I am sure managing our health by genetic testing as standard is the future, but will take years & years because early exposure of (possible) conditions would give a chance of managing & treating so retaining a better health. Quite a dilemma for profit seeking Big Pharma.

[radd in reply to radd]

Once identified the clinical significance of this mutation, particularly the consequences of long term untreated hypothyroidism would justify screening family members of people with the IGSF1 mutation.

I have hereditary haemochromatosis. Every article advises offspring to be tested but NHS specialists advise they are not allowed. Thank goodness for the 23andme test. 😃

[Tugun in reply to galathea]

Thanks - Very interesting article.

[userotc]

Getting back to your friend's son!.. A key weakness of all forums is there's a strong tendency to focus on the subject of the forum - in this case thyroid. He appears to have an overall problem which maybe can't be properly addressed here/with thyroid treatment.

Personally I'd suggest he considers a practitioner in the area of concern who would consider everything relevant eg all medication ever taken.... My profile shows I've been down that route and still following it by own research etc.

[Val-55 in reply to userotc]

Thankyou for your reply , yes he has managed to find a specialist in men’s health / testosterone problems and is going to see him soon . I have suffered with under active thyroid problems for years as has his mum . I didn’t know that it could cause low testosterone in men ! He is only young and it is affecting his work and relationships .... you have to watch them so closely don’t you and hopefully try andun ravel the problem , with a lot of your own research !!!

[userotc in reply to Val-55]

Thanks. If he isnt happy to continue with a practitioner eg cost or insistence on TRT, Id suggest he does some research instead (or as well as). Maybe advise him to try Total Male Optimization website and Swolesource forum? I use these.

[Hypopotamus]

In my experience the range for testosterone levels is very wide, and doctors looking at blood tests make no allowance for your age or health. If you are in range, you are in range.

I have always had low results, and although I managed on two occasions to get them to prescribe me the gel, it made absolutely no difference to me.

[Val-55]

It seems to be a lottery ... bit like thyroid treatment ! He has tried the cream ,, his oestrogen and testosterone now too high and he is extremely tired and puffy ,,, !

[Flatdanny in reply to Val-55]

Unfortunately 99% of doctors are clueless when it comes to sex hormones. If you think it’s hard finding a knowledgable doctor to deal with a thyroid issue then try and find a decent doctor to treat someone with low testosterone. I’ve been dealing with similar issue for quite a while now and came to the conclusion I would need to take control of my own health care in this area.

There are a number of issues. Doctor should not really treat for low testosterone before addressing any thyroid issue. Things often get worse if the underlying thyroid issue is not sorted first.

Treatment for low testosterone is actually reasonably simple. Gels are not a great treatment choice to be honest. He would be better with injectable testosterone. Starting dose would normally be 100mg per week, which can be split into two 50mg injections. High E2 (oestrogen) will rarely be an issue and taking an anti oestrogen medication is not really recommended anymore.

I’d be interested in viewing his testosterone related bloods if you can post those?

[Val-55 in reply to Flatdanny]

I think it is what I’m fearing what you are saying ... it is a very complicated balancing act I can see ... I will see if he will send me his recent medi check blood tests , see what you think .. the specialist he is seeing is in Poole in Dorset ,, all holding out a lot of hope !

[Flatdanny in reply to Val-55]

Well happy to take a look at his bloods if he wants to share. I think I know the doctor in Poole. If it's who I think it is, I think he's pretty decent. Good place to start I guess (:

[Val-55 in reply to Flatdanny]

Thankyou 🤞

[SilverAvocado]

I would suggest he thinks about going to Bluehorizon or Medichecks and gets a finger prick mail order test to get full thyroid results. Something useful to take to the specialist and see if they will take them into account. If he doesn't have any evidence there is a thyroid link he might have a harder time persuading the specialist to do the tests. At the same time he should read up and be prepared to ask questions about thyroid. As I'm sure you know, often we have to do most of the work with doctors!

The main things to get are TSH, freeT4, freeT3, and the antibodies. It's always worth getting vitsmins, too, if budget allows, ferritin, folate, vit B12, and vit D. There are quite a few sex hormone packages and tests available, so there may be some he'd have liked done but hasn't been able to get on the NHS.

It would be great to rule thyroid out, although those results look suspicious. If he has thyroid antibodies then his thyroid function will deterioriate over time, so it's good to know and good to have a few blood tests in the bank to monitor (I also suggest he makes a file and keeps copies of all blood tests. If he's had lots in the past and doesn't have copies, it's possible to apply to get a copy of the whole record). It's possible to have both Hashimotos and Central Hypo at the same time, but it would be very unlucky

[Val-55]

Thankyou so much for your kind advice . Yes I will get him to do full thyroid check , he has had quite a few medichecks , testosterone tests . Yes I’ve been sending him lots of reading ref thyroid and low testosterone hopefully ,, this mens health specialist he is seeing shortly will have more of a clue !

[BadHare]

Testosterone is needed for thyroid hormone conversion. Perhaps trying a different type of testosterone would help him. As we know, there's no one size fits all with hormone therapy. Perhaps following guidelines for micronutrient intake & Hashimoto's could help, too.

I have a relative, one of several with thyroid issues, who's hormonal ill health turned out to be hypogonadism rather than my hypo symptoms which are pituitary related. The symptoms were identical to mine, & also a male aquaintance that I know from my local Pituitary Foundation group, but an MRI showed no tumour. As our hormone system is closed, it only takes one thing to have a knock on effect with our other hormones.

ps Tostran gel seems to be working well for my relative, though I'm not sure how many types of testosterone gel are available on the market. It could be like T4 & HRT, etc, that doctors prescribe the cheapest drugs first & don't mention there are better meds available.

[radd in reply to BadHare]

BadHare,

Can you please explain how .. [ testosterone is needed for thyroid hormone conversion . ] .. 🤔

[BadHare]

Apologies radd , I can't find the articles I read 2 years ago, but this might explain how the hormones are related: thyroidadvisor.com/relation...

ncbi.nlm.nih.gov/pubmed/168...