Relation between TSH and Test levels

tricks79

Active member
Trusted Member
#1
Hey Team,

I'm asking this for a relative. I've been pestering them to get their test checked for a while because I had my suspicions. Lo and behold he has low low low test. (reference range is 8-29, he is 8.6, I forget the units but doesn't matter).

Doctor prescribed him TRT. Doc prescribed 200mg Test-e Every 2 weeks. We all know this is an absolutely idiotic protocol but w.e, I'm urging him to get it revised to at least once a week injections at minimum.

He's pretty excited to get started and hopefully clear up all of these LOW t sides he has. Anyway interesting thing that came up on the blood panel was that TSH was also quite high. (I'll get exact numbers soon but it wasn't just marginally out of range).

He will be getting T3/T4 tested on next panel.

I'm asking from your more experienced folk here what the relationship between high TSH and low Test could be? The reason this is important is because if there is an underlying cause for his low t, he rather treat that problem rather than hop on TRT as a band-aid solution.

What else should he be looking at? What pieces of the puzzle may we not be considering.


Side note is he lives a very sedentary life style due to back problems. Can't really exercise if he wanted too. Not obese but has a dad-bod for sure. His wife is a vegetarian so he probably doesn't eat as much animal meat as he should to accommodate family meals. Works from an office chair all day. There is a history of thyroid issues in the female side of my family.

Paging @Peter Akara
 
#2
I cant answer your question SPECIFICALLY.

What I can do is provide my own experience.
My TSH was through the roof when I got tested.

(I also lost my eyebrows over the years, typical of a dead Thyroid)
My test levels are in the mid range (I am mid thirties)
This testing was done before I got put on thyroid meds.

Now that I am on T3/4, I have gotten a new round of tests, and my test levels have not changed.
 

Peter Akara

Member
Trusted Member
#3
How old is he?

The relationship is that both the testes and thyroid are ultimately under control of the hypothalamus, and therefore the pituitary. There are possible situations both can be surpressed at a central/brain level, but this is not the case. His TSH is high because the brain is trying to get the thyroid to produce more thyroid hormone. This means the issue is in the thyroid, not the brain. Which leads to my next point.

How high was his TSH? If it's borderline elevated (which I would bet money on), I wouldn't worry about it in the first place. However it sounds like his doctor is ordering T3T4 levels before prescribing synthroid, which is good as there is a diagnosis called subclinical hypothyroidism. This is where TSH is elevated, but ultimately the T3/T4 levels (which is all we really care about at the end of the day) are normal. In this situation you monitor and don't need any intervention.

Lastly, to play devils advocate. By definition his testosterone is NOT low, esp if he's 50+. I wouldn't prescribe TRT in this situation. If there's a complication of blood clot, stroke, etc... Then medicolegally, this physician will have a tough time justifying their management...
 

tricks79

Active member
Trusted Member
#4
How old is he?

The relationship is that both the testes and thyroid are ultimately under control of the hypothalamus, and therefore the pituitary. There are possible situations both can be surpressed at a central/brain level, but this is not the case. His TSH is high because the brain is trying to get the thyroid to produce more thyroid hormone. This means the issue is in the thyroid, not the brain. Which leads to my next point.

How high was his TSH? If it's borderline elevated (which I would bet money on), I wouldn't worry about it in the first place. However it sounds like his doctor is ordering T3T4 levels before prescribing synthroid, which is good as there is a diagnosis called subclinical hypothyroidism. This is where TSH is elevated, but ultimately the T3/T4 levels (which is all we really care about at the end of the day) are normal. In this situation you monitor and don't need any intervention.

Lastly, to play devils advocate. By definition his testosterone is NOT low, esp if he's 50+. I wouldn't prescribe TRT in this situation. If there's a complication of blood clot, stroke, etc... Then medicolegally, this physician will have a tough time justifying their management...
Thanks for the reply, he is early 30s. Maybe 32?
 

Peter Akara

Member
Trusted Member
#5
Thanks for the reply, he is early 30s. Maybe 32?
Your welcome. I've been MIA for a while, very busy with work, so my reply is pretty late.

Ultimately, I think his symptoms which you said are consistent with low testosterone are likely more relating to his sedentary lifestyle and medical issues. This is a hard thing to bring up to patients as they become fixated it must be testosterone related. However if he's excited about the prescription and that will get him working out consistently (even regular walks, cycling, etc... I understand he has low back pain) + Better diet, I gaurentee his energy and libido will increase. But this will be from the exercise, not the testosterone IMHO
 

animal-inside

Well-known member
Trusted Member
#6
How old is he?

The relationship is that both the testes and thyroid are ultimately under control of the hypothalamus, and therefore the pituitary. There are possible situations both can be surpressed at a central/brain level, but this is not the case. His TSH is high because the brain is trying to get the thyroid to produce more thyroid hormone. This means the issue is in the thyroid, not the brain. Which leads to my next point.

How high was his TSH? If it's borderline elevated (which I would bet money on), I wouldn't worry about it in the first place. However it sounds like his doctor is ordering T3T4 levels before prescribing synthroid, which is good as there is a diagnosis called subclinical hypothyroidism. This is where TSH is elevated, but ultimately the T3/T4 levels (which is all we really care about at the end of the day) are normal. In this situation you monitor and don't need any intervention.

Lastly, to play devils advocate. By definition his testosterone is NOT low, esp if he's 50+. I wouldn't prescribe TRT in this situation. If there's a complication of blood clot, stroke, etc... Then medicolegally, this physician will have a tough time justifying their management...
Good explanation..!

TSH is telling the body to produce more thyroid hormone. If you have high TSH, your thyroid isn't producing enough for what the body is wanting to be at. It's a bit more complicated then t3/t4 though.. getting those checked will deffinitely be a good start.

There is more connections between thyroid and testosterone though. There's guys on here who coudl do a much better job ecplaining than myself.


The thinking of not prescribing TRT because of 50+ is old ways of thinking to my understanding. If your body needs TRT to be normal, it's better to give it. There is tons of increased risk of not treating low test at any age.

8.2 is very low for 32... Each clinic has their own range they use (which is retarded).... my endo at a big hospital and my GP in a tiny town both use the range of 15 to 29.99 for a man in their 30's..

Also, if the doctor sticks with 200mg once every two weeks, just go with it.. But get the doctor to agreed to let him self inject than he can follow any schedule he wishes.
 

animal-inside

Well-known member
Trusted Member
#7
Your welcome. I've been MIA for a while, very busy with work, so my reply is pretty late.

Ultimately, I think his symptoms which you said are consistent with low testosterone are likely more relating to his sedentary lifestyle and medical issues. This is a hard thing to bring up to patients as they become fixated it must be testosterone related. However if he's excited about the prescription and that will get him working out consistently (even regular walks, cycling, etc... I understand he has low back pain) + Better diet, I gaurentee his energy and libido will increase. But this will be from the exercise, not the testosterone IMHO
GOod points, but I think for 32 he's considered clinically low, beyond what his lifestyle would ever do to him.

He should deffinitely mke some lifestlye changes with the TRT!
 
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