Just when you thought that family doctors would never learn about prescribing T3:

Jacqueline Jonklaas, Professor in the endocrinology division at Georgetown University, has submitted a paper entitled “Evidence-Based Use of Levothyroxine/Liothyronine Combinations in TreatingHypothyroidism”

Below are excerpts from a (2nd March, 2021) report in Medscape Medical News:

“Numerous trials have been conducted on short-acting liothyronine (LT3) in combination with the standard therapy of levothyroxine (LT4). However, the experts agreed that shortcomings in the existing studies and mounting unanswered questions need to be addressed, Jacqueline Jonklaas, MD, PhD, told Medscape Medical News“……………

“Patient-reported outcomes were acknowledged as essential in the full picture of understanding treatment efficacy, and the experts agreed that an emphasis on those outcomes will be important in any future trials of combination therapy.”

“Among the key topics agreed upon is the need to evaluate a sustained-release T3 preparation. Such a preparation could overcome concern of the dissipation of circulating T3 that occurs with oral tablet formulations, which fail to achieve the relatively stable levels seen in normal individuals, Jonklaas noted.”

“There was unanimous agreement that when and if a sustained-release T3 preparation became available and had undergone preliminary testing, new trials with such a preparation were definitely warranted,” she said. Preliminary testing of a new product that potentially provides sustained release of T3 has recently started.


THIS MEANS that doctors have finally begun to listen what patients have been saying for the past many years: the accepted treatment of hypothyroidism using Ltroxin and Synthroid doesn’t work and the time has come to prescribe T3, or a combination of T3 and T4, instead.

So in a couple of years, the use of slow-release T3 will be accepted, the misery of millions who have been treated with T4 alone will come to an end and “the system” will authorise prescription of slow-release T3 as a “covered” medication.


An endocrine hormone is a molecule produced by a hormone-secreting gland and carried by the blood to another organ, whose behavior it controls. Generally, the Hormone plugs into a specific receptor protein in the target cell, changing the shape of the receptor protein and thereby, producing a change in cell function.

Hormones are used to communicate between organs and tissues to regulate physiological and behavioral activities, such as digestion, metabolism, respiration, tissue function, sleep, excretion, lactation, stress, growth and development, movement, reproduction and mood.

It is also possible for a cell to produce a hormone to control activity within itself [an “Intracrine” hormone] or to control nearby cells in the same organ [a “paracrine” hormone].

There are many kinds of hormone molecules: eicosanoids, steroids, amino acid derivatives, peptides, proteins etc.

Some are soluble in water, while some only dissolve in oils and fats (lipids). The lipid-soluble ones need special transport proteins in the blood, to transport them from their gland of origin, to the target organ.

Hormones pack a powerful punch, in terms of their effect on the body. Therefore they need to be “balanced”: produced in exactly the right amounts, at the right time, to keep the target organs running smoothly and to keep the body as a whole, “in tune”. This is achieved by a delicate; but effective “feedback system” in which a chemical [often, another hormone] produced by the target cell goes back to the hormone producing gland, which can tell how much target hormone is present in the blood and modifies its production accordingly.

They are also produced in a “diurnal rhythm”, with maximum production at a particular time of day. Each hormone has its own rhythm. For example thyroid 3 hormone is boosted at 4 AM and testosterone at 8 AM.

The brain controls hormone production and the system is rather like an amplified orchestra:

[1] The Pineal gland is the (diurnal) timer, to tell the system when to sleep and when to play.

[2] The Hypothalamus detects input signals from the hormonal glands, skin nerves, blood chemicals, intestines, eyes, ears and emotions (in fact, the whole body), and balances the output of control hormones by the Pituitary.

[3] The Pituitary gland, like a conductor, tells the individual players when and how forcefully, to play their part.

If all is in balance, the individual player does just the right amount of work and the system is in tune.

Outside of the brain, there are many players:

Major “generalist” glands like the skin, the thyroid, the parathyroids, the pancreas, the intestine, the adrenals and the gonads (ovaries in the female and testicles in the male) produce hormones which affect the entire body,

Specialist” hormone producers like the kidneys, stomach, bowel, placenta and the fat make hormones which are included in the Hypothalamus’ calculations, but also act directly on other specific glands or tissues.

Micro factories in all the cells process Pregnenolone, DHEA, Levothyroxine (“thyroid #4 hormone”, or “T4”), Cortisol and other “generalist” hormones into specific molecules for that cell’s own maintenance and repair.


Every cell in your body, from your skin and hair, to your brain and all your other parts, dances to the beat of your hormones and can only function optimally when they are “in tune”.

Hormonal imbalance can be responsible for physical dysfunction, including obesity, for cognitive dysfunction including “fuzzy thinking”, for psychological dysfunction, including anxiety, panic attacks and depression and perhaps for Alzheimer’s disease.

Therefore in a significant proportion of cases, hormonal “restoration” or “rebalancing” will return the individual to stable, normal function.

G. A. Harry, MD.


1: DEFINITION – Wikipedia:https://en.wikipedia.org/wiki/Hormone

2: RECEPTORS – Wikipedia:https://en.wikipedia.org/wiki/Receptor_(biochemistry)

3: TRANSPORT PROTEINS – Wikipedia:https://en.wikipedia.org/wiki/Transport_protein

4: PINEAL GLAND – Britannica:https://www.britannica.com/science/pineal-gland

5: HYPOTHALAMUS – Britannica:https://www.britannica.com/science/hypothalamus

6: PITUITARY – Merck:https://www.merckmanuals.com/en-ca/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/overview-of-the-pituitary-gland


[A]: 17 BETA HYDROXY STEROID DEHYDROGENASES https://www.ncbi.nlm.nih.gov/pubmed/11091120

[B] INTRACRINOLOGY (Prof Fernand Labrie) https://www.ncbi.nlm.nih.gov/pubmed/10915214

8: THYROID GLAND FUNCTION – https://mcb.berkeley.edu/courses/mcb135e/thyroid.html

9: REGARDING AGING – https://www.nature.com/articles/d41586-018-05582-3

10: EVERYTHING YOU WANTED TO KNOW ABOUT THE PINEAL GLAND – https://www.globalhealingcenter.com/natural-health/everything-you-wanted-to-know-about-the-pineal-gland/#1


G. A. Harry, MD [Retired]


The letters “DHEA” are an acronym for DEHYDROEPIANDROSTERONE: this is the hormone which is produced in greatest quantity by the youthful human body. In smaller animals, the hormone is produced entirely in the brain and blood levels tend to be very low. The brains of humans and the Primates also make DHEA, but in addition the adrenal glands process cholesterol into Pregnenolone, from which DHEA is made in such large amounts in youth, that weight-for-weight, it exceeds the aggregate of all the other hormones.
DHEA levels are high at birth because the mother produces large amounts during pregnancy and the hormone crosses the placenta to the baby. Levels fall rapidly after birth and remain low until age 8 – 13 or so, at which point both males and females begin to maximise DHEA production.

DHEA circulates in the blood stream and is used by all cells in the body, individually, to produce such hormones and hormone byproducts as each particular cell needs for efficient function: Intracellular hormonogenesis has been termed “Intracrine” by Dr. Fernand Labrie, Professor of Endocrinology at the University of Laval.

The DHEA molecule is modified by a family of “3 beta hydroxy steroid dehydrogenase” enzymes, producing dozens of different “micro-hormones” and from those, further modifications are made, so that within each cell, a specialised hormone mix is produced, which facilitates the function of that particular cell type: this is part of the reason why the ends of your fingers make fingernails, while special cells in your bones make blood, et cetera.

Beginning at age 25-30 in females and 35 (or earlier) in males, production falls by approximately 1-3% per annum, so that by age 80 the blood contains mainly intracerebrally-produced DHEA, with hardly any output by the Adrenals. Thus the blood level in old age is 10 % or less of that at age 20.

As with everything else in nature, there is a “spread”, Bell-curve-wise, of DHEA levels in youth. The disparity between the highest and lowest rate of synthesis is maintained throughout life, so that those with the lowest production early on tend towards zero production in old age. At the left end of the bell curve, there is a small proportion of the population whose DHEA production is suboptimal even in the teenage years and “80-year-old” serum concentrations can at times, be seen in the second decade.

Thus a deficiency in production of DHEA can be found at any age and can lead to inefficiency of hormonal function in any part [or many parts] of the body, including the central nervous system and the “immune system”. Because of this, the clinical manifestations of DHEA deficiency vary from person to person, depending on which of an individual’s organs happens to be most sensitive to reduction in its availability. The symptoms are therefore highly variable. The commonest problems in both sexes, however are those which result from Testosterone deficiency; this is not a surprising finding, given the multiplicity of functions which that hormone subserves.

The subject of DHEA is a bone of contention in the medical community; there are 3 “teams”: very enthusiastic lay people who think that everybody should supplement their DHEA so as to slow down aging, researchers who are mostly “pro” and a group of naysayers and doomsayers, whose objections are mainly of the “What if”, “Perhaps” and “We don’t know, so we can’t recommend it” variety.

In view of this it is important to note that in spite of the easy, “OTC” availability of DHEA in the USA, no life-threatening complication has ensued: as Dr. Fernand Labrie, Professor of Endocrinology at Laval U. and an acknowledged expert in the field avers, no serious adverse event related to DHEA has ever been reported in the world literature (thousands of subjects exposed) or in the monitoring of adverse events by the FDA (millions of subjects exposed)”.

The bottom line of all this is that without a good supply of DHEA, something is bound to go haywire and the corollary is, restoring your DHEA and maintaining it at youthful levels promotes ongoing normal function in all parts of the body, not just in those obvious functions which depend on testosterone.

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