- Joined
- Dec 5, 2007
- Messages
- 505
Here's something I've just found out, and it doesn't seem to be very mainstream knowledge, especially with those who go on TRT.
Some background: I've been increasingly over the last 4-5 years been having symptoms of dry skin, brittle nails/hair, fatigue, a little bit of weight gain around the middle, joint pain, and a few other symptoms. It has gotten to the point that it is starting to drive me nuts. From my research, everything points to hypothyroid symptoms. I went in to have my blood tested, and the doc will only test TSH and free T4. They come back in the normal range (although TSH may be on the higher side at 3.3). The doc won't treat my symptoms because of the lab values, doesn't care how I feel, he has to have lab values out of range for him to justify anything. He kept trying to cite how Harvard experts determined the ranges for TSH, etc. (really? Harvard? Like I give a care!)
I have just now come across Journal references that refer to thyroid problems when being on TRT or taking anabolic androgenic steroids in general.
Apparently, thyroid binding globulin is reduced in the liver which effectively reduces the half-life of T3 in the blood. The cells don't get what they need from the T3 so we end up with hypothyroid symptoms even though production of TSH and T4 are tested as "normal." The only other way to reveal some of what is actually happening is to test free T3 and Reverse-T3 because this change in half-life means the body will convert more T4 over to reverse-T3. T3 should be 20 times higher than reverse-T3. If the ratio is off, you get hypothyroid symptoms. Not too many docs know about this, but the good ones who know their stuff will adjust for thyroid as well and put you on a small dose of T3. If you are a bodybuilder, it's also a good idea then to have a small dose of T3 along with your cycle.
I'm curious to know if there is anyone else on TRT who has been having similar problems. I've been on TRT for almost 16 years straight, and these symptoms onset very gradually. I have only noticed them much more for the last 4-5 years, and they have continued to worsen steadily. I always thought it was just something I had to live with because I was getting older. Now I know differently.
**broken link removed**
Ingestion of androgenic-anabolic steroids induces mild thyroidal impairment in male body builders.
R Deyssig, and M Weissel
DOI: **broken link removed**
Published Online: July 01, 2013
ABSTRACT PDF
Abstract
Self-administration of very high doses of androgenic anabolic steroids is common use in power athletes because of their favorable effect on performance. Since androgenic steroids decrease serum T4-binding globulin (TBG) concentrations dramatically, we were interested in the effects of this procedure on thyroid function: we performed TRH tests (200 micrograms Relefact, i.v.), with blood withdrawal before and for 180 min after injection, for determination, using RIA kits, of serum concentrations of total and free T4, total T3, TSH, and TBG in 13 young (20-29 yr old) male body builders with clinically normal thyroid glands, who were all in the same state of training. Five of these athletes admitted taking androgenic anabolic steroids at an average total dose of 1.2 g/week for at least 6 weeks before the tests. TBG, total T4, and total T3 were significantly (P < 0.001) decreased, whereas basal TSH and free T4 were not significantly different from the values of the other 8 without androgenic steroids. The maximum TSH increase after TRH administration (mean +/- SE, 16 -/+ 6 vs. 9 -/+ 4 mU/L; P < 0.05) was relatively increased, whereas the T3 response to TRH (0.61 -/+ 0.10 vs. 1.13 -/+ 0.13 nmol/L; P < 0.05) was relatively decreased in the group receiving androgens. The 5 patients taking androgens had significantly greater weight (114 vs. 90 kg; P < 0.01) and higher total cholesterol levels (6.3 -/+ 1.3 vs. 3.8 -/+ 0.3 mmol/L; P < 0.05) together with very low high density lipoprotein cholesterol levels (0.20 -/+ 0.03 vs. 1.03 -/+ 0.10; P < 0.001) than the controls. PRL levels were normal and similar in both groups. We conclude from our results that high dose androgenic anabolic steroid administration leads to a relative impairment (within the normal range) of thyroid function. Whether this is due to a direct thyroid hormone release (or synthesis?)-blocking effect of these steroids needs further investigation.
**broken link removed**
Sex steroids and the thyroid
Rundsarah Tahboub, MD (Fellow in Endocrinology), Baha M. Arafah, MD (Professor of Medicine; Director of Clinical Program & Fellowship Training Program)correspondenceemail
Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA
DOI: http://dx.doi.org/10.1016/j.beem.2009.06.005
Thyroid function is modulated by genetic and environmental causes as well as other illnesses and medications such as gonadal or sex steroids. The latter class of drugs (sex steroids) modulates thyroid function. Gonadal steroids exert their influence on thyroid function primarily by altering the clearance of thyroxine-binding globulin (TBG). While oestrogen administration causes an increase in serum TBG concentration, androgen therapy results in a decrease in this binding protein. These effects of gonadal steroids on TBG clearance and concentration are modulated by the chemical structure of the steroid being used, its dose and the route of administration. Despite the gonadal steroids-induced changes in serum TBG concentrations, subjects with normal thyroid glands maintain clinical and biochemical euthyroidism without changes in their serum free thyroxine (T4) or thyroid-stimulating hormone (TSH) levels. In contrast, the administration of gonadal steroids to patients with thyroid diseases causes significant biochemical and clinical alterations requiring changes in the doses of thyroid medications. Similarly, gonadal steroid therapy might unmask thyroid illness in previously undiagnosed subjects. It would be prudent to assess thyroid function in subjects with thyroid disease 6–8 weeks after gonadal steroid administration or withdrawal.
References
Bagatell, C.J., Bremner, W.J. Androgens in men - uses and abuses. The New England Journal of Medicine. 1996;334:707–714.
CrossRef | PubMed | Scopus (307)
Ain, K.B., Mori, Y., Refetoff, S. Reduced clearance rate of thyroxine-binding globulin (TBG) with increased sialylation: a mechanism for estrogen induced elevation of serum TBG concentration. The Journal of Clinical Endocrinology and Metabolism. 1987;65:689–696.
CrossRef | PubMed
Surke, M.I., Sievert, R. Drugs and thyroid function. The New England Journal of Medicine. 1995;333:1688–1694.
CrossRef | PubMed
Kester, M.H., Van Dijik, C.H., Tibboel, D. et al, Sulfation of thyroid hormone by estrogen sulfotransferase. The Journal of Clinical Endocrinology and Metabolism. 1999;84:2577–2580.
CrossRef | PubMed
Sitruk-Ware, R., Plu-Bureau, G., Menard, J. et al, Effects of transvaginal ethinyl estradiol on hemostatic factors and hepatic proteins in a randomized, cross over study. The Journal of Clinical Endocrinology and Metabolism. 2007;92:2074–2079.
CrossRef | PubMed | Scopus (38)
Shifren, J.L., Rifai, N., Desines, S. et al, A comparison of the short-term effects of oral conjugated equine estrogens versus transdermal estradiol on C-Reactive Protein, other serum markers of inflammation, other hepatic proteins in naturally menopausal women. The Journal of Clinical Endocrinology and Metabolism. 2008;93:1702–1710.
CrossRef | PubMed | Scopus (39)
Shifren, J.L., Desindes, S., McIlwain, M. A randomized, open label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones and adrenal hormones in naturally menopausal women. Menopause. 2007;14:985–994.
CrossRef | PubMed | Scopus (35)
Dickson, R.B., Eisenfeld, A.J. 17 alpha-ethinyl estradiol is more potent than estradiol in receptor interactions with isolated hepatic parenchymal cells. Endocrinology. 1981;108:1511–1518.
CrossRef | PubMed
Goebelsman, U., Mashchak, C.A., Mishell, D.R. Jr. Comparison of hepatic impact of oral and vaginal administration of ethinyl estradiol. American Journal of Obstetrics and Gynecology. 1985;151:868–877.
PubMed
Mashchak, C.A., Lobo, R.A., Donzono-Takano, R. et al, Comparison pharmacodynamic properties of various estrogen formulations. American Journal of Obstetrics and Gynecology. 1982;144:511–518.
PubMed
Arafah, B.M. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. The New England Journal of Medicine. 2001;344:1743–1749.
CrossRef | PubMed | Scopus (137)
Bisschop, P.H., Toorians, A.W., Endert, E. et al, The effects of sex-steroid administration on the pituitary-thyroid axis in transsexuals. European Journal of Endocrinology. 2006;155:11–16.
CrossRef | PubMed | Scopus (11)
Van Bon, A.C., Wiersinga, W.M. Goserelin-induced transient thyrotoxicosis in a hypothyroid woman on L-thyroxine replacement. The Netherlands Journal of Medicine. 2008;66:256–258.
PubMed
Zaninovich, A.A. Effects of oestrogen on thyroxine turnover in hyperthyroidism. Acta Endocrinologica. 1972;71:491–497.
PubMed
Schatz, D.L., Palter, H.C., Russell, C.S. Effects of oral contraceptives and pregnancy on thyroid function. Canadian Medical Association Journal. 1968;99:882–886.
PubMed
Mandel, S.J., Larsen, P.R., Seely, E.W. et al, Increased need for thyroxine during pregnancy in women with primary hypothyroidism. The New England Journal of Medicine. 1990;323:91–96.
CrossRef | PubMed
Alexander, E.K., Marqusee, E., Lawrence, J. et al, Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. The New England Journal of Medicine. 2004;351:241–249.
CrossRef | PubMed | Scopus (288)
Anker, G.B., Lonning, P.E., Aakvaag, A. et al, Thyroid function in postmenopausal breast cancer patients treated with tamoxifen. Scandinavian Journal of Clinical and Laboratory Investigation. 1998;58:103–107.
CrossRef | PubMed | Scopus (28)
Marqusee, E., Braverman, L.E., Lawrence, J. et al, The effect of droloxifene and estrogen on thyroid function in postmenopausal women. The Journal of Clinical Endocrinology and Metabolism. 2000;85:4407–4410.
CrossRef | PubMed | Scopus (29)
Arafah, B.M. Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer. Annals of Internal Medicine. 1994;121:247–251.
CrossRef | PubMed
Braverman, L.E., Ingbar, S.H. Effects of norethandrolone on the transport in serum and peripheral turnover of thyroxine. The Journal of Clinical Endocrinology and Metabolism. 1967;27:389–396.
CrossRef | PubMed
Graham, R.L., Gambrell, R.D. Changes in thyroid function tests during danazol therapy. Obstetrics and Gyneoclogy. 1980;55:395–397.
PubMed
Deyssig, R., Weiseel, M. Ingestion of androgenic anabolic steroids induces mild thyroidal impairment in male body builders. The Journal of Clinical Endocrinology and Metabolism. 1993;76:1069–1071.
CrossRef | PubMed | Scopus (24)
Some background: I've been increasingly over the last 4-5 years been having symptoms of dry skin, brittle nails/hair, fatigue, a little bit of weight gain around the middle, joint pain, and a few other symptoms. It has gotten to the point that it is starting to drive me nuts. From my research, everything points to hypothyroid symptoms. I went in to have my blood tested, and the doc will only test TSH and free T4. They come back in the normal range (although TSH may be on the higher side at 3.3). The doc won't treat my symptoms because of the lab values, doesn't care how I feel, he has to have lab values out of range for him to justify anything. He kept trying to cite how Harvard experts determined the ranges for TSH, etc. (really? Harvard? Like I give a care!)
I have just now come across Journal references that refer to thyroid problems when being on TRT or taking anabolic androgenic steroids in general.
Apparently, thyroid binding globulin is reduced in the liver which effectively reduces the half-life of T3 in the blood. The cells don't get what they need from the T3 so we end up with hypothyroid symptoms even though production of TSH and T4 are tested as "normal." The only other way to reveal some of what is actually happening is to test free T3 and Reverse-T3 because this change in half-life means the body will convert more T4 over to reverse-T3. T3 should be 20 times higher than reverse-T3. If the ratio is off, you get hypothyroid symptoms. Not too many docs know about this, but the good ones who know their stuff will adjust for thyroid as well and put you on a small dose of T3. If you are a bodybuilder, it's also a good idea then to have a small dose of T3 along with your cycle.
I'm curious to know if there is anyone else on TRT who has been having similar problems. I've been on TRT for almost 16 years straight, and these symptoms onset very gradually. I have only noticed them much more for the last 4-5 years, and they have continued to worsen steadily. I always thought it was just something I had to live with because I was getting older. Now I know differently.
**broken link removed**
Ingestion of androgenic-anabolic steroids induces mild thyroidal impairment in male body builders.
R Deyssig, and M Weissel
DOI: **broken link removed**
Published Online: July 01, 2013
ABSTRACT PDF
Abstract
Self-administration of very high doses of androgenic anabolic steroids is common use in power athletes because of their favorable effect on performance. Since androgenic steroids decrease serum T4-binding globulin (TBG) concentrations dramatically, we were interested in the effects of this procedure on thyroid function: we performed TRH tests (200 micrograms Relefact, i.v.), with blood withdrawal before and for 180 min after injection, for determination, using RIA kits, of serum concentrations of total and free T4, total T3, TSH, and TBG in 13 young (20-29 yr old) male body builders with clinically normal thyroid glands, who were all in the same state of training. Five of these athletes admitted taking androgenic anabolic steroids at an average total dose of 1.2 g/week for at least 6 weeks before the tests. TBG, total T4, and total T3 were significantly (P < 0.001) decreased, whereas basal TSH and free T4 were not significantly different from the values of the other 8 without androgenic steroids. The maximum TSH increase after TRH administration (mean +/- SE, 16 -/+ 6 vs. 9 -/+ 4 mU/L; P < 0.05) was relatively increased, whereas the T3 response to TRH (0.61 -/+ 0.10 vs. 1.13 -/+ 0.13 nmol/L; P < 0.05) was relatively decreased in the group receiving androgens. The 5 patients taking androgens had significantly greater weight (114 vs. 90 kg; P < 0.01) and higher total cholesterol levels (6.3 -/+ 1.3 vs. 3.8 -/+ 0.3 mmol/L; P < 0.05) together with very low high density lipoprotein cholesterol levels (0.20 -/+ 0.03 vs. 1.03 -/+ 0.10; P < 0.001) than the controls. PRL levels were normal and similar in both groups. We conclude from our results that high dose androgenic anabolic steroid administration leads to a relative impairment (within the normal range) of thyroid function. Whether this is due to a direct thyroid hormone release (or synthesis?)-blocking effect of these steroids needs further investigation.
**broken link removed**
Sex steroids and the thyroid
Rundsarah Tahboub, MD (Fellow in Endocrinology), Baha M. Arafah, MD (Professor of Medicine; Director of Clinical Program & Fellowship Training Program)correspondenceemail
Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA
DOI: http://dx.doi.org/10.1016/j.beem.2009.06.005
Thyroid function is modulated by genetic and environmental causes as well as other illnesses and medications such as gonadal or sex steroids. The latter class of drugs (sex steroids) modulates thyroid function. Gonadal steroids exert their influence on thyroid function primarily by altering the clearance of thyroxine-binding globulin (TBG). While oestrogen administration causes an increase in serum TBG concentration, androgen therapy results in a decrease in this binding protein. These effects of gonadal steroids on TBG clearance and concentration are modulated by the chemical structure of the steroid being used, its dose and the route of administration. Despite the gonadal steroids-induced changes in serum TBG concentrations, subjects with normal thyroid glands maintain clinical and biochemical euthyroidism without changes in their serum free thyroxine (T4) or thyroid-stimulating hormone (TSH) levels. In contrast, the administration of gonadal steroids to patients with thyroid diseases causes significant biochemical and clinical alterations requiring changes in the doses of thyroid medications. Similarly, gonadal steroid therapy might unmask thyroid illness in previously undiagnosed subjects. It would be prudent to assess thyroid function in subjects with thyroid disease 6–8 weeks after gonadal steroid administration or withdrawal.
References
Bagatell, C.J., Bremner, W.J. Androgens in men - uses and abuses. The New England Journal of Medicine. 1996;334:707–714.
CrossRef | PubMed | Scopus (307)
Ain, K.B., Mori, Y., Refetoff, S. Reduced clearance rate of thyroxine-binding globulin (TBG) with increased sialylation: a mechanism for estrogen induced elevation of serum TBG concentration. The Journal of Clinical Endocrinology and Metabolism. 1987;65:689–696.
CrossRef | PubMed
Surke, M.I., Sievert, R. Drugs and thyroid function. The New England Journal of Medicine. 1995;333:1688–1694.
CrossRef | PubMed
Kester, M.H., Van Dijik, C.H., Tibboel, D. et al, Sulfation of thyroid hormone by estrogen sulfotransferase. The Journal of Clinical Endocrinology and Metabolism. 1999;84:2577–2580.
CrossRef | PubMed
Sitruk-Ware, R., Plu-Bureau, G., Menard, J. et al, Effects of transvaginal ethinyl estradiol on hemostatic factors and hepatic proteins in a randomized, cross over study. The Journal of Clinical Endocrinology and Metabolism. 2007;92:2074–2079.
CrossRef | PubMed | Scopus (38)
Shifren, J.L., Rifai, N., Desines, S. et al, A comparison of the short-term effects of oral conjugated equine estrogens versus transdermal estradiol on C-Reactive Protein, other serum markers of inflammation, other hepatic proteins in naturally menopausal women. The Journal of Clinical Endocrinology and Metabolism. 2008;93:1702–1710.
CrossRef | PubMed | Scopus (39)
Shifren, J.L., Desindes, S., McIlwain, M. A randomized, open label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones and adrenal hormones in naturally menopausal women. Menopause. 2007;14:985–994.
CrossRef | PubMed | Scopus (35)
Dickson, R.B., Eisenfeld, A.J. 17 alpha-ethinyl estradiol is more potent than estradiol in receptor interactions with isolated hepatic parenchymal cells. Endocrinology. 1981;108:1511–1518.
CrossRef | PubMed
Goebelsman, U., Mashchak, C.A., Mishell, D.R. Jr. Comparison of hepatic impact of oral and vaginal administration of ethinyl estradiol. American Journal of Obstetrics and Gynecology. 1985;151:868–877.
PubMed
Mashchak, C.A., Lobo, R.A., Donzono-Takano, R. et al, Comparison pharmacodynamic properties of various estrogen formulations. American Journal of Obstetrics and Gynecology. 1982;144:511–518.
PubMed
Arafah, B.M. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. The New England Journal of Medicine. 2001;344:1743–1749.
CrossRef | PubMed | Scopus (137)
Bisschop, P.H., Toorians, A.W., Endert, E. et al, The effects of sex-steroid administration on the pituitary-thyroid axis in transsexuals. European Journal of Endocrinology. 2006;155:11–16.
CrossRef | PubMed | Scopus (11)
Van Bon, A.C., Wiersinga, W.M. Goserelin-induced transient thyrotoxicosis in a hypothyroid woman on L-thyroxine replacement. The Netherlands Journal of Medicine. 2008;66:256–258.
PubMed
Zaninovich, A.A. Effects of oestrogen on thyroxine turnover in hyperthyroidism. Acta Endocrinologica. 1972;71:491–497.
PubMed
Schatz, D.L., Palter, H.C., Russell, C.S. Effects of oral contraceptives and pregnancy on thyroid function. Canadian Medical Association Journal. 1968;99:882–886.
PubMed
Mandel, S.J., Larsen, P.R., Seely, E.W. et al, Increased need for thyroxine during pregnancy in women with primary hypothyroidism. The New England Journal of Medicine. 1990;323:91–96.
CrossRef | PubMed
Alexander, E.K., Marqusee, E., Lawrence, J. et al, Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. The New England Journal of Medicine. 2004;351:241–249.
CrossRef | PubMed | Scopus (288)
Anker, G.B., Lonning, P.E., Aakvaag, A. et al, Thyroid function in postmenopausal breast cancer patients treated with tamoxifen. Scandinavian Journal of Clinical and Laboratory Investigation. 1998;58:103–107.
CrossRef | PubMed | Scopus (28)
Marqusee, E., Braverman, L.E., Lawrence, J. et al, The effect of droloxifene and estrogen on thyroid function in postmenopausal women. The Journal of Clinical Endocrinology and Metabolism. 2000;85:4407–4410.
CrossRef | PubMed | Scopus (29)
Arafah, B.M. Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer. Annals of Internal Medicine. 1994;121:247–251.
CrossRef | PubMed
Braverman, L.E., Ingbar, S.H. Effects of norethandrolone on the transport in serum and peripheral turnover of thyroxine. The Journal of Clinical Endocrinology and Metabolism. 1967;27:389–396.
CrossRef | PubMed
Graham, R.L., Gambrell, R.D. Changes in thyroid function tests during danazol therapy. Obstetrics and Gyneoclogy. 1980;55:395–397.
PubMed
Deyssig, R., Weiseel, M. Ingestion of androgenic anabolic steroids induces mild thyroidal impairment in male body builders. The Journal of Clinical Endocrinology and Metabolism. 1993;76:1069–1071.
CrossRef | PubMed | Scopus (24)