Hypogonadism? You have decent T levels as they are why would you go on T shots or gel?

This can be improved very easily to get it even higher. By titrating Thyroid/Adrenal dosages.

Also what is your diet like? if it is low fat then theirs your answers. What are your cholesterol levels? Use Hemp seed butter, EVCO, Extra Virgin Olive Oil, organic eggs etc…

What are your cortisol levels? Even though you are on 20mg of cortisol your blood work looks like that of someone with low cortisol or adrenal fatigue. I base that on Low DHEA’s, low IGF-1, High Free T3 with a low Free T4 and elevated RT3.

If your only issue was elevated RT3 than use Plain T3 by itself and drop the naturethyroid to clear it out. But that microadenoma could be causing RT3 issue no doubt.

Your symptoms could be caused by the adenoma itself. How is your vision?

@andybean 2308 wrote:

My serum testosterone levels have varied between 200 and 550. My new doctor thinks that serum levels are not the best indicator and relies on 24hr urine testing from Rhein Labs, which is what produced the low level 40 (normal range 45-85). Symptomatically, I have ED and low libido, so doctors seem quick to prescribe T gel.

I think my diet is good. I eat a lot of fat–coconut oil, EVOO, raw grass-fed butter and cream, etc., sea salt for the adrenals. I’m wondering now if I just need more HC. I’m at 25mg daily and my temp are just starting to stabilize. Maybe a little more and the T3 will start to get in my cells? I find it strange that I have such high FT3 levels on only 2 grains of Nature-throid.

Cortisol before I began HC was:

Salivary cortisol – ZRT labs
8am 5.4 (3.7 – 9.5)
Noon 2.1 (1.2 – 3.0)
4pm 2.7 (0.6 – 1.9)
8pm 0.6 (0.4 – 1.0)

My vision is slightly blurry. I have very slight myopia (-.25) and moderate astigmatism (-1). I wear glasses occasionally.

I didn’t know about the RT3 numbers until this week. I’ve always had low DHEA and low to mid T. I’m wondering about the microadenoma and if prolactin could be involved. I should probably get a follow-up MRI to see if anything has changed, but my sense is that I should get the right HC and thyroid meds going first and see what happens.

Does that make sense, or do you see something else I should be looking into?

Thanks for your help.

No problems.

It would have been interesting to see your blood cortisol levels what they we’re on that high level of FT3. You are right just get thyroid/adrenals balanced and it should improve. But i still believe your body could be making all that RT3 due to the adenoma it is just a self-defence mechanism to slow metabolism when any kind of illness takes hold within the body if not then it’s a cortisol issue.

Your ferritin is high which could indicate hyperthyroid but your labs don’t correlate with that so maybe some hidden inflammation is taking place in your body. How is your digestion?

Man i have ED and low libido but has nothing to do with testosterone perse, T improves once thyroid and cortisol signaling improve. I have hashimoto’s thyroiditis started thyroid meds T4/T3 was good for maybe what 2 days then crashing due to RT3 and cortisol issues. I then switched to plain T3 60mcg per day and much better but still crashing after a week. Added a little isocort made all the difference, had no sex drive or energy/motivation on thyroid alone now at least its coming back. Have to do bloods again as we all do.

The pattern i usually see on bloodwork is when you have Low cortisol = Low IGF-1 and Low Free T with High SHBG. Once cortisol is up to normal IGF-1, T goes up SHBG goes back down to normal. And we obviously know low or high cortisol causes thyroid resistance with ongoing hypo symptoms which is why it’s so important to regulate it.

It’s also possible your ED is being cause by the Adenoma itself not your T levels. Definitely get a follow-up MRI and see what is going on with it. Also look into possible heavy metal burden which can effect everything.