Latest results - fT3 overrange after commencing TRT

[Decant]

Hi,

I posted the other day with an endo recomendation request and it was understandably closed for comments, but I'd appreciate any general comments on these results please.

I'm a man. I started TRT (Testosterone Replacement Therapy) 4 months ago and just had follow up consultation after bloods this Monday 2nd October. My thyroid bloods are now

TSH 0.01 mIU/L (0.27 - 4.2) -6.6%

Free T4 (fT4) 17.6 pmol/L (12 - 22) 56.0%

Free T3 (fT3) 7.56 pmol/L (3.1 - 6.8) 120.5%

T4:T3 Ratio 2.328 

Previously in May 2023 (pre TRT, same dose of Levo at 125 mcg and Lio at 18.75 mcg), my results were

TSH 0.02 mIU/L (0.27 - 4.2) -6.4%

Free T4 (fT4) 14.2 pmol/L (12 - 22) 22.0%

Free T3 (fT3) 5.84 pmol/L (3.1 - 6.8) 74.1%

T4:T3 Ratio 2.432 

I find it very interesting in general that my fT3 has risen so much with the intoduction of TRT. I know there is linkage between everything hormonal and that the testes have thyroid hormone receptors.

Annoyingly the latest blood test didn't include vitamins but they were all pretty good in May and I'm good with my supplementation routine (vit D3+K2, Magnesium, B-complex with additional B12).

I am contemplating reducing my T3 and/or reducing or stopping my testosterone therapy, and I'd appreciate any comments on that please! My options seem to be

1. Stop TRT and keep thyroid meds as they are. In 3-4 months retest and see about optimising T3 again.

2. Continue with TRT at least for another 3 months, perhaps on a lower dose of testosterone.

3. Continue TRT at a lower dose, but also reduce T3 a little (e.g. 15 mcg), but then that's playing with two variables.

All blood draws were done following the protocol. My diet is about the same (pretty good), and I do moderate exercise. Sleep is pretty bad (early waking).

Clearly my fT3 has significantly increased and is now overrange.

The thing is that the TRT results are now all in the red. I won't post them as I know you guys have no opinion on them. The doctor at the TRT clinic said my results are fine and to be expected as I inject testosterone. I don't think he's looking at me "in the round" holistically. He is suggesting I continue the trial for another 3 months. It costs of course, but I'm not noticing any real symptom relief (energy, motivation, brain-fog, sleep, exercise capacity, etc). I would need to spend money to stop TRT (to kick start my own testosterone production again).

I've been looking for an answer for decades to general malaise and this was the last throw of the dice after getting my thyroid and lifestyle in good shape. Probably a malingering hypochondriac that just needs to get on with things and count my blessings! My malaise is probably psychological.

My wife is understandably running out of patience at me endlessly looking for some "silver bullet" with all the procrastination and cost involved.

I do worry that I've been conned into TRT. Guys on a TRT forum said they wouldn't have started with my initial testosterone levels, even though it's quite above board to have done so. NHS wouldn't treat with my levels, but that wouldn't surprise long-time thyroid sufferers!

Many thanks!

[greygoose]

I've probably asked this before, but I'll ask it again: Are you, or have you ever been, on statins?

[Decant in reply to greygoose]

No, I've never taken statins. I've refused them when suggested and I've got my cholesterol results under control now.

[greygoose in reply to Decant]

OK. I just asked because taking statins would cause low testosterone.

1. Stop TRT and keep thyroid meds as they are. In 3-4 months retest and see about optimising T3 again.

You are assuming that optimal is a number, but it isn't. It's how you feel. Did you feel optimal before starting the TRT? Probably not, or you wouldn't have started it. But, how do you feel now?

2. Continue with TRT at least for another 3 months, perhaps on a lower dose of testosterone.

That sounds like the best option to me. But, I'm no expert on testosterone.

3. Continue TRT at a lower dose, but also reduce T3 a little (e.g. 15 mcg), but then that's playing with two variables.

As you say, that would involve two variables, which isn't a good idea. But, why would you want to reduce them both, anyway? If the FT3 is high because of the testosterone dose, it should come down by itself when the testosterone dose is lowered.

But what about:

4. Reduce dose of T3 and keep testosterone the same?

However, I'm wondering, do you still have a working thyroid - I mean one that would work a little if all thyroid hormone therapy was stopped? Or have you had your thyroid removed/RAI/killed off by Hashi's? Because if you haven't got a thyroid, where is that extra T3 coming from? Could it be a faulty test?

[Decant in reply to greygoose]

1. Stop TRT - I didn't feel optimal pre-TRT. I don't feel much/any better now: certainly not what I was hoping for. Still bad sleep (it was awful with soaking the bed with sweat over summer). Low motivation but that could just be that I'm not working and I'm feeling stressed with no money coming in - motivation is quite likely psychological. I am still hoping for a magic treatment, when things are probably as good as they can be and I need acceptance. Be thankful for my blessings and move forward.

2. Continue TRT for another 3 months - this is what I'm leaning towards, though the over-range fT3 "concerns" me.

4. Reduce T3, keeping TRT - indeed this is the other option!

My testosterone (and cholesterol) levels did improve somewhat after my thyroid med changes over the last year or so.

That's a good question about how fT3 has risen without a T3 dose change and a possible faulty test. I'm loathe to spend out on another test and blood draw (I'm not earning right now). Could there be another explanation like rT3 (I know very little about that)?

I had RAI almost 20 years ago, so I don't have a (fully) working thyroid.

[greygoose in reply to Decant]

motivation is quite likely psychological

Not entirely, no. To be motivated you do need good energy levels. If you haven't got those then everything seems like too much trouble.

I am still hoping for a magic treatment, when things are probably as good as they can be and I need acceptance.

Aren't we all! But it's very hard to know when things are as good as they can be - how do we know that things can't get better if... It's a tricky one, that is.

Continue TRT for another 3 months - this is what I'm leaning towards, though the over-range fT3 "concerns" me.

Well, at least if you do that, which is what your endo recommended, at least you will know you gave it your best shot. If you give up on it now, there will always be that doubt at the back of your mind. What if...

I wouldn't be overly concerned about the T3, not for three months. If it's still high after you finish the TRT, then it might be cause for concern, but quite honestly, it's not that high. Remember, ranges are only rough guides, not cast-iron rules.

I can't think of another explanation for the high FT3 - because I really don't know everything, or even half of everything. But it could be possibly that less is getting into the cells than it used to. Why that would be, I don't know. But, I don't think it has anything to do with rT3. With excess rT3 you would expect someone to have low levels of FT3, not high ones, because it's usually to do with poor conversion and more T4 being converted to rT3 and less to FT3.

[Decant in reply to greygoose]

Motivation

I know motivation needs good energy levels. Mine are "good enough" (I will keep working on them though). I now think motivation is psychological as I've been out of work for a while (again) and hit a mental wall when sitting down to apply for roles. I've been a computer programmer for 30+ years and it's different (less interaction and variety) to how it used to be.

Continuing TRT

I wasn't seen by an endo, just a doctor, which is fuelling my anxiety at the TRT treatment. Do you think I should experiment with a lower liothyronine dose (15 down from 18.75) or leave it alone? I fiddle too frequently but deeper sleep would be nice, not that it's totally awful (especially if I remember my sleep hygeine).

Thank you x

[DippyDame]

Any help?

edenclinicformen.com/post/t...

[Decant in reply to DippyDame]

Thank you for the link. In conjunction with what greygoose pondered why fT3 has gone up without a dose change, it led me to find that most T3 is converted from T4 in the liver and (new to me) the gut - upto 20%. Zoe study did report my gut flora to be reduced (I'd not long had anti-biotics). I generally eat healthily and do drink kefir most days so perhaps my gut is better than it has been? But I see that there is a suggested link between the two systems, so perhaps the increased testosterone is making the liver, etc convert more T4 to T3.

redriverhealthandwellness.c...

I see little reason to not continue on TRT for another 3 months to complete this trial. I am reducing my T3 to 15 mcg/day (from18.75) - perhaps that will help me sleep a little better.

[DippyDame in reply to Decant]

I'd suggest you complete the trial then test again and re-evaluate.

Good luck