Avatar universal

Low Testosterone and Hypothyroidism

To: doctornee medical
My husband has been fighting a low testosterone level for some time now.  He has seen an endo who has diagnosed him with hypothyroidism. He has been receiving treatments of Synthroid and Androgel.  Unfortunately, as his TSH levels go up, his T levels are going down:
12/20/2006  222 3.397
2/5/2007   182 n/a
5/12/2007    251 4.74
8/28/2007   240 4.139
12/10/2007  388 3.849
3/18/2007   273 3.909
6/16/2008   170 2.888
9/17/2008   n/a 2.382

He is now taking 112mcg of Synthroid daily along with Androgel.
His PSA came back negative.
He does not have any ED symptoms, but his testicles have reduced in size.
He has low energy (from a man who was always on the go), sweats, memory problems (from a man who had an impressive memory), has had a few dizzy episodes, has been having continuous headaches for the last several months and is starting to have some breathing problems.
Any advice would be greatly appreciated.

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Avatar universal
thanks Gimel to inpart a bit of sanity.  I too have gone to peakTestosterone site and they have a very active forum with some very knowledgable members, as well as real Dr's who specialize in hormones, specifically mens hormones but also do women as well who chime in from time to time.

First off while I agree most Dr's are not taught properly in med school about thyroid and other hormones, there is no reason to throw EVERY doctor under the bus. There still ARE some good doctors out there.  Finding them is the key.

And the key to all of it is to educate yourself.

Syhthroid or any synthetic T4 medication is not evil and it does work for a large percentage of people.  Many Dr's have been taught that Armour or any natural dessicated thyroid (NDT) medication like Armour is horrible and variation and just plain bad.  So if you want to begin treatment you are more apt to find a Dr who will prescribe T4 only.  This is not bad, in fact I would recommend normally that this is the place to s tart.  But you have to get tested with FT4 and FT3 EVERy time and after each dosage change.  Only after you see how the blood labs change and how you are feeling do you make a determination if additional, or a switch to another medication is the best choice.

The protocol I would recommend for someone starting on thyroid replacment is  to start with T4 only.  Dose and increase dosing after testing after 6 weeks being on the dose.  Keep increasing the doseage until you EITHER, Feel well, or you get your Free T4 to 50% of the range.  If you do not feel well at this point and your FT3 is not up to at least 50%, then you can add in small dose of T3 (Cytomel), or you could make a wholesale change to NDT (Armour).  But I typically do not recommend throwing the baby out with the bathwater and think that simply adding in and making small adjustments in T3 and T4 dosage levels to get you to alleviate symptoms.

I also agree that treating thyroid is probably 1st order of business, unless the testosterone levels are drastically low.  Thyroid sets the metabolism rate of the entire body. This includes how  hormones convert and interact. it is specifically the various enzymes that are designed to work in a body that is 98 degrees, and if hypo thyroid, and low temp, all these enzymes needed to properly work hormones are stunted and slowed and less effective.  So helping thyroid levels CAN help tesosteroine levels. No gurnantees, and no gurantees that the help or improvement will be enough to not need testosterone replacement.

Men typically have a poor absorption rate with any type of topical cream or gel.  many men may even start out responding well to a T gel, but after a time.  could be a few months or even a few years and many men will become resistent to the absorption and the gels are no longer effective.

application location of gels is important.  and applying a cream/gel to the scrotum is up to 800% more effective for absorption.  So in poor absorption men, this may be an option, but because of the drastically increased abdorption rate (Typical absorption on the abdomen is only about 10%) your Dr may have to reduce the application volume if you choose to apply to scrotum.

Hormones are VERy complicate dnd VERY inter-related often times.  Upssetting one will often  have a ripple effect and this can vary from person to person.

It is very important that like thyroid, testosterone you MUST insist on several tests. If not done, the Dr is just guessing and it is trial and error, and the patient will be on a roller coaster of H - E Double hockey sticks!

Tests for testosterone are:

Total Testosterone
Free Testosteroine
Estradiol (E2)  preferrably the sensetive mass spectrometer test

as previously mentioned LH and FSH is also important, especially prior to starting Testosteorne replecement to determine if the low T is primary or secondary.

SHBG is VERY important number to have.  As it along with Total T can calculate a free testosterone level and seems to be more stable than the serum based free T test.  Also SHBG also helps to determine the frequency rate of testosterone injections.

Similar to problems seen in thyroid treatment.  Dr's are OLD SCHOOL and injecting Testosterone once every two weeks is obsolete and usually a disaster.  Even once a week is pushing it.  More peeople seem to be finding that small dose injections twice or even more a week seem to work best.  This is especially true for people with low SHBG.  ANd is exactly why obtaining this test value is so important to proper treatment protocol.

MANY of the same symptoms overlap between low thyroid and low testosterone.  Namely, weight gain, fatigue, anxiety, depression, brain fog and lack of libido.
Helpful - 0
Avatar universal
Rather than considering the shots, I would suggest that you should read this link.


After reading that I think you will be more inclined to first make sure your hypothyroidism is under control.  I say that because I fully expect that you are like so many other hypothyroid patients that are not being adequately tested and treated.  If you will please post your last several sets of thyroid related tests and their reference ranges shown on the lab report, and also tell us about any symptoms you have, we will be glad to give you our assessment of your status.  
Helpful - 0
Avatar universal
Hello, I have hypothyroidism and a testosterone level of 291. I would prefer shots of testosterone is that likely
Helpful - 0
Avatar universal
24 and total testosterone of only 304?
uh, 304 is too damn low!
304 is the testosterone level of a 100 year old man.
the "normal" range doctors go by is 1000-300...a range created by gathering test subjects made up of random men between the ages of 20 to 100 years of age. The average 20 year old's average testosterone level is around 1000. the average 100 year old man's testosterone level is around 300.
in other words you have the testosterone levels of an old impotent geezer! your docs are dumb, stupid, inept, incompetent frauds. they don't know wht they are doing, and its screwing up your health. they aren't taking into account your age, height, and weight in accessing your blood work!
as usual, endos are useless.
look up testosterone levels by age group, print out image flowcharts, make a paper plane out of it, and toss it at your knuckleheaded doctor and ask him/her why they are screwing up your life by being so damn ignorant.
Helpful - 0
Avatar universal
Im 24 & came across a low thyroid problem one year ago and now facing testosterone problems im at total of 304 and I am having sex problems too.I told my regular dr. About sayd it was all in my head tht everything was okay. I went to another place were they do hormone test and took my own list of test I wanted done im not gona lie there were like 20 test I wanted done amr they were just missing 2 tht ran me around $600... I still havent gone to get my results....  by the way im on armour thyroid 30mg.
This thyroid n testosterone issue suck...
Ill post my results and see what happens....
I wish all to get better on this....
Helpful - 0
Hi Johny;
Have you got the results, I know this has been a longtime ago.

Very curious to know.

Avatar universal
Amour Thyroid is a naturally derived thyroxine from pigs. I have been on this for 2 1/2 years and have no side effects from the medication (now at 90mg per day) . For Low T I inject 1ml of testosterone cypionate (200mg/ml) each week. To avoid the complications for estrogen conversion I take 1mg of ansatrozole 1x per week. I agree, you should find a better DR. who listens to your concerns.
Helpful - 0
Avatar universal
PLease trust me..you do NOT want to be on Synthroid. I have a son and a husbnad with thyroid issues..please please understand that your Dr. was NOT TAUGHT the right information in Med school and is now messing with your life. There is hope..I've seen my hubby change his life. Synthroid is NOT GOINGTO WORK FOR ABOUT 75% of people... the BigPharma drug companies have told Docs to use when it DOES NOT MAKE MOST PEOPLE FEEL WELL! And it will keep you sick. Read Stop the thyroid maddness website and also the National  academy of Hypothyroidism and you will see that you should be on Dessicated Thyroid Medication and also possibly Cytomel and you need a DIFFERENT set of tests run. DO the entire list of tests and you will start to know how to get better. PLEASE IGNORE your DR. when they say you are "in range"..in range can make you feel like you are dying. read the sites! The Stop the thyroid maddness site will list all the tests you need run and the supplements you MUST be on. Good luck
Helpful - 0
Avatar universal
i'm am 29 years old and just found out that i have a thyroid condition, i am now taking .25mcd synthroid but i'm curious if i may have a testosterone problem as well because i'm tired all the time, don't want to have sex or work out anything just overall lack of not giving a damn. you know, my question is that will the synthroid make every thing start working correctly.
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Avatar universal
I think his relative lack of response to androgel indicates that a large ammount of his testosterone is being converted to estrogen/estradiol and this in turn is causing an increase in globulin bound thyroid. Maybe do additional tests to check it. Blocking aromatase would be a step to take if this is the case. Bear in mind I have no idea what i'm talking about but want to sound smart. Good luck.
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Avatar universal
I'm going to double my dose. Your husband and I are in very similar situations. I'm 30, and have been on synthroid (.112) for 15 years. I began testosterone (testim 1%)  2 1/2 years ago. I have hoshimoto's thyroiditus, which I was told is what brought my Testosterone problem on.

The doctors tell me my testosterone problem is idiopathic. Thats not good enough, I want to know exactly why Im taking this Testim.

I recently had a change in testosterone and have felt very fatigued. I was on 1 tube a day, and had a normal blood level of 1100. I recently got checked and the doc said I was at 750 and should increase it to 2 tubes a day. Im going to try it, I hope this gets me back to normal.

Does anyone know who or where to go to to find out WHY we have these testosterone problems?
Helpful - 0
523918 tn?1244549831
Low thyroid hormone activity often results in insulin resistance. Insulin resistance is another factor that reduces testosterone production. It interferes with LH production and may also directly reduce testicular testosterone production. I'm sure the ENDO asked for:
He should also test for free T3, free T4, free testosterone (total is Ok, but just to compare), DHT and estradiol levels. People with hypothyroidism sometimes have problems in absorpsion of transdermic testosterone because of the skin become thick. Whish is the dose of androgel? 5g? 10g??
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