Thyroid/Pituitary Disorder and Treatment

[Nate2014]

     Hi everyone.  I am a 20 year old college student.  I lead a fairly active lifestyle playing tennis for my college.  I am approximately 5’10” and 185 pounds.   Summed up, I suffer from borderline hypothyroidism and hypogonadism.  Genetics: My father suffers from hypothyroidism, but there is no noted hypogonadism.  Since the age of twelve, I have suffered from most all symptoms of each disorder to varying degrees; the main being: fatigue, depression, anxiety, and lack of motivation.  They have been life-altering.  The worst though, is the constant fatigue I have experienced which has turned me into a “zombie-like” person.   I tried to combat it through lifestyle choices, but it seemed futile.  After twisting his arm for more than one year, my family physician tested my testosterone which sent me on a journey the past six months or so.  The first endocrinologist I visited recognized my hypothyroidism and hypogonadism as two different issues stemming from a thyroid and pituitary disorder..  As treating my thyroid required a lesser treatment, he prescribed me 50mcgs of Synthroid.  His plan was to treat my thyroid and determine if it was sufficient in relieving my symptoms.  Unfortunately, it was not.  The next step was testosterone substitution.  Knowing this is a more serious commitment, I searched for a second opinion.  A second endocrinologist confirmed both the diagnosis and need for testosterone substitution.  Through him, I began taking Androgel 1.62% four days ago.  I have had a constant headache but it seems to be subsiding today.  I also have chapped lips.  
     In the first reply, I have posted all my test results.  Please advise me with anything you consider useful as well as the treatment I present below.  Being a twenty year old with borderline results, I have been told contradictory information on both my diagnosis and treatment.  It is very confusing.  
     Right now I am trying to design a treatment that works for me.  Before I go into this it is worth mentioning that I have a girlfriend.   Transference is a worry.  Right now I apply one pump or 20.25mgs of Androgel 1.62%.  As I mentioned above, I experience constant headaches and dry lips.  I hope they continue to subside.  Recently, I have been familiarizing myself with Doctor John Crisler’s method.  I am considering implementing subcutaneous HCG injections daily.  My testicular function is important to me.  Please let me know your opinion on this treatment.
If there are any questions I am more than happy to answer them promptly.
I am sorry the tests do not include units.  I figured the range would provide sufficient relativity to interpret.

[solace21]

Hi,
   Assuming the test were taken before starting the medication, I note that in your case cortisol is raised and FSH is consistently on the lower side. Though the T level is low, I thought that an acceptable range for T was like 240 to 1200 , in which case you may be still within limits. Also your free T is still within range which suggests that the SHBG in your case is low. Personally I would have thought a more detailed liver test should have been done to look for problems like a fatty liver etc, which in turn should be managed with appropriate diet control and if SHBG could be raised, your T count could go up.

Again T level can reduce if you do vigorous exercise, and reducing the exercise to moderate level can push up the T level.

Prozac may be also causing a reduction in T level as well as FSH.

The higher level of cortisol may be a worry factor. Detailed checking of  adrenal health may be done.

I could not think your thyroid readings any way suggests you have a problem with Thyroid.

In my opinion, based on my ignorance level, you should not have gone for T replacement, I would still suggest you to go to a better equipped hospital and get an overall health check up done to find the real reason behind your constant fatigue rather than substituting T.

You are only twenty. so better take care.

Good luck,
Solace
  

[Nate2014]

I am sorry the tests do not include units.  I figured the range would provide sufficient relativity to interpret.
Testosterone, Serum: 265 (348-1197)
This was concerning, so another more extensive test followed.
TSH: 2.360 (0.450-4.500)
LH: 4.2 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
Testosterone, Serum: 330 (348-1197)
Prolactin: 8.5 (4.0-15.2)
The next test was issued by my first endocrinologist.
Free Testosterone (Direct): 9.4 (9.3-26.5)
Testosterone, Total, Lc/Ms: 253.9 (348-1197)
LH: 4.1 (1.7-8.6)
FSH: 1.1 (1.5-12.4)
The next test my first endocrinologist ordered because I had been off Prozac for one week and figured why not.

Cortisol: 20.8 (2.3-19.4)
TSH: 4.2: (0.450-4.500)
I had an MRI done, and the results came back clear.
This is the most recent test.
Thyroid Panel With TSH
TSH: 1.930 (0.450-4.500)
Thyroxine (T4): 9.6 (4.5-12.0)
T3 Uptake: 34 (24-39)
Free Thyroxine Index: 3.3 (1.2-4.9)
Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab: 8 (0-34)
Antithyroglobulin Ab: <20 (0-40)
Luteinizing Hormone (LH): 7.3 (1.7-8.6(
FSH, Serum: 1.3 (1.5-12.4)
Calcitonin, Serum: <2.0 (0.0-8.4)
Reverse T3, Serum: 21.5 (9.2-24.1)
Vitamin D, 25-Hydroxy: 32.6 (30.0-100.0)
Triiodothyronine (T3): 115 (71-180)
Estrogens, Total: 83 (40-115)
Ferritin, Serum: 70 (30-400)
Triiodothyronine, Free, Serum: 3.7 (2.0-4.4)

I do not know if this is important, however, these tests were taken at 8 AM. This could cause for the imbalance in some tests, as I had not eaten. I wonder if this impacted: Calcitonin, Serum; Ferritin, Serum, or Vitamin D, 25-Hydoxy

It is also important to note, I am currently taking 20mg of Adderall in the morning; 50mcgs of Synthroid in the morning; and 10mg of Prozac at night.