T Nation

18, Past Anorexia Athletica, Former TRT


#1

Hey guys

Starting from when I was about 13, I went through a period of working out relentlessly, without properly compensating nutrition-wise. Long story short, I was diagnosed with anorexia, despite eating consistently over 2000 cals per day.

In 2013, with the advice of my endo, I jumped on TRT (intramuscular injections, 2x month), and stayed on for over a year. About 7 months ago, I went completely cold-turkey, after my T levels started to drop while I tapered the TRT off (my endo promised me that I would just taper off easily, and there'd be no problem.. which was total bullshit of course).

Well, here I am five years after starting what was a complete downward spiral for my life, and I still am struggling to get my HPTA axis to restart.

I have low TSH AND low LH, yet I also have low t3 and t4, and extremely low testosterone (no production whatsoever, aside from the paltry amount produced by my adrenals: my levels are 68 ng/dcl right now!!)

Here are my labs, and bear in mind that my t3 levels appear this way because I was on 25 mcg cytomel BID for a month prior to having these taken):

t4 - <0.4 (0.7-1.48) ng/dl

t3- 2.7 (1.73-3.71) pg/ml

TSH- 0.3 (0.4 - 4.7)uIU/ml

SHBG 70 (11-80) nmol/L

Testosterone T/bioavailable total- 68 (300-1200) ng/dl

Leptin 0.7 ng/ml

I don't have the numbers off hand, but I know my estradiol is practically nonexistent.

I'm looking for someway to jump-start my HPTA axis, that won't require long-term dependence on exogenous hormones, medications, or injections. Does anyone know of something that could help?


#2

There is a lot of reading you need to do:

In the 2nd post of the 1st forum topic, follow these links:
- advice for new guys
- things that damage your hormones
- HPTA restart
- thyroid basics

What has happened to your testes and scrotum?

Your thyroid meds seem insufficient. You can use body temperatures as a dosing guide.

High SHBG is a problem.

Have you had prolactin tested?


#3

I have done quite a bit of reading already KSman.

I know my SHBG levels aren't optimal, but clearly I'm having no T production whatsoever (aside from the tiny amount my adrenals are putting out), so the SHBG/T ratio is inconsequential at this juncture (my T is so low, that it doesn't really matter- I don't have any T for SHBG to block)!

I don't know what my prolactin is, but I don't have an APT if that's what you're wondering.. I've had two separate MRIs that have both confirmed this.

My boys down below are perfectly fine (no shrinkage there).

My temperatures even on 25 mcg cytomel BID were still below normal (in the mid-97 degree F range)


#4

High SHBG is unexpected and thus a symptom of something unknown. SHBG is made in the liver, so some process is affecting the liver.
AST/ATL OK?

If E2 is very low, blinding the HPTA to E2 with a SERM might be a failure. So that would close many possible approaches. If you tried a SERM, you would test to see if there was any induced LH/FSH.

Then hCG would be the next obvious approach, but not the outcome that you seek.

Your testicular production of pregnenolone might be low.
Have you tested DHEA-S?
AM Cortisol?

What are your fasting cholesterol levels. Low cholesterol can affect production of hormones.


#5

What do you mean by AST/ATL?

Does that have something to do with the caloric restriction?


#6

Oh, and Ksman, I realized just now that I totally spaced on including my LH numbers.

LH- 0.8 (1.3-7.1) mIU/mL
Tanner stage 1: <1.2 mIU/mL
Tanner stage 2: <1.2 mIU/mL
Tanner stage 3: <2.3 mIU/mL
Tanner stage 4: <4.9 mIU/mL
Tanner stage 5: 0.6-5.9 mIU/mL

Prolactin- 3.3 (2.8-15.6) ng/mL

I don't have any numbers for fasting cholesterol, AM cortisol, or DHEA-S....


#7

Oh, sorry, one more thing!

In the HPTA Restart Protocol topic, you said this-

"We know that hypothyroid states can lead to low LH and low T. So the prospects of a HPTA restart may be poor in such states. There is more to sexual functioning than your T levels. Do not have T tunnel vision. Note the other health issues and causes in the advice for new guys sticky. If there is a cause for low T, you need to identify and fix that."

Since I'm essentially in a hypothyroid state, based on my t3 and t4 levels, and my temperatures, what should I do? Is there no way to kickstart my HPTA again so that it functions on its own?

I know this will inevitably take a long time to fix, if it's fixable at all, but I'm leaving for college soon, and I don't want to struggle through my education, performing at a sub-par level, because of this goddamn brain-fog and fatigue!! :frowning:


#8

You have to focus on two different problems.

With the reading, you will see that your starvation may involve elevated rT3 that can make things worse. You could try to get rT3 tested to have a better understanding of what you are dealing with.

Do you think that iodine deficiency might be part of why you became hypo thyroid?


#9

I don't think it's an iodine deficiency, since I take iodine supplement daily, and eat seaweed quite often.

So, what do you think I should do?


#10

KSman? Sorry to bug you, but I didn't know if you could see my last reply, since I think I replied to the thread, not your specific comment.


#11

KSman, I ordered the labs you suggested. One thing I do want to know though is, why would a SERM not be effective due to my low estradiol levels? I've read through the stickies, and I still don't understand why.


#12

AST/ALT are typically referred to as markers for liver problems; however, these are not liver specific. Your liver clears estrogens from your blood. Some drugs/meds, Rx and OTC can also interfere with clearance.

Have you read the topics that IK suggested? You seem to be asking about some things that you should know from that.

Prolactin is not a cause.

Did you ever get estradiol/E2 tested?
If elevated, that might explain high SHBG and a SERM might help.
If low, then lowering further with a SERM might not work.


#13

My last estradiol reading was <10.0 (<38.4) pg/ml.
I'm assuming this means that using a SERM won't work....

If so, what route should I take with a restart? How should I modify the restart protocol you've outlined in the HPTA restart thread? Should I just use HCG?

I really want to get moving on FINALLY addressing this, so I apologize if I seem impatient. I feel awful most of the time, and I want this to just end.


#14

Your E2 is very low now. So one would not expect that using a SERM to hide the E2 from the hypothalamus would work. But sometimes you throw a brick through the window to see what happens.

In this case, SHBG might be high as a reflex to low T levels.

As the problem seems to be clearly in the hypothalamus and/or pituitary, it makes sense to suspect that the problem might be something that could be detect with a MRI. There could be a pituitary adinoma and we know that it would be non FSH or prolactin secreting. You want to know this as such things can press on the optic nerves if large. A MRI might so some other kind of abnormality.

The pituitary can be damaged by a blow to the head or major whiplash.

Why do I need to beg to get your lab work spoon fed?
Have you posted everything now?

Thyroid and body temperatures:
I pointed out that you were under medicated. You need to be able to increase your dose while watching body temperatures.


KSman is Here
KSman is Here
#15

My morning temperatures for Wednesday, Thursday, and Friday (of this week, so just a few days ago) were 97.7, 97.8, and 98.6.

Like I mentioned above, I've had two separate MRIs done, and neither of them found a tumor. Moreover, before I got down to an unhealthy weight, I had raging hormones, and everything worked perfectly.

I have now posted all of my most recent labwork...

I really have two questions:

1.) So should I try the HPTA protocol you've outlined elsewhere, and if so, is it something that I can use to permenantly get my HPTA axis up and running on its own again (so that I'm not left having to take a SERM and HCG for the potential improvements in hormone levels to remain)????

2.) Does my hypothyroid state need to be addressed first?

Can't I address both problems at the same time?


#16

Wow, I don't know why the two questions I asked were blown up like that. . Sorry KSman!!


#17

KSman, I got my DHEA-S, cholesterol, and cortisol checked, but the results are still pending.

I really just want to start SOMETHING, because I believe, as you've said, that the top end of my HPTA is currently shut down.

I think that my thyroid and T problems may both originate from that- the lazy, semiconscious state that my hypothalamus seems to be in right now.

From what I understand, HCG won't help then, right? In the "KSman is here" thread you said in a response to someone else's comment that HCG shuts down the top end of the HPTA axis, because it's a precursor to LH.. am I correct in thinking this?

My morning temps for the last few days have actually been higher- 98.1, 98.4, and 98.2. I checked my mid-afternoon temp yesterday and it was 98.0 as well.

However, my latest labs (drawn this past Wednesday) show :

T3 (Free): 2.1 (2.9-4.6) pg/ml
T3 (total): 55 (76-181) ng/dl
TSH: 1.29 (0.5-4.3) mIU/L

My T3 is still below normal, but my TSH seems to be rebounding (I presume because I've been off cytomel for a few weeks now).

What do you think my TSH's apparent turnaround means?

By the way, over the past 7 months since I've stopped TRT, my body has been steadily gaining fat. I've gained about 6 lbs over that period, all in my abdominal region. Since I know of no way to effectively lose BF with hypothyroidism and low T, I'm not worrying about it right now, but I am afraid of this trend continuing.


#18

OH, and one last thing- I made a mistake, my cholesterol DID come back, and it was:

158 (125-170) mg/dl

So cholesterol doesn't seem to be a problem.


#19

Ksman, here's

(Total) TEST. -102 (250-827) ng/dL

(Total) T3- 55 (76-181) ng/dL

CORTISOL - 15.4 (4-22) mcg/dL

T3 REVERSE - 22 (8-25) ng/dL

DHEA SULFATE- 220 (24-537) mcg/dL

ESTRADIOL - 16 (< OR = 39) pg/mL

LEAD, BLOOD 0.9 (<10 considered "safe") mcg/dL


#20

Your decent body temps and low T3, fT3 are quite strange.
And your rT3 would be expected to be interfering with fT3 and lowering body temperatures.
You are not fitting a normal pattern where I might otherwise be able to suggest anything.
Temperatures were what when T3, fT3, rT3 were tested?

hCG goes direct to the testes and then T might improve.
Anything that increases T or estrogens will lower LH/FSH

hCG is not a precursor to LH. LH and hCG have identical lobes that activate LH receptors.

A restart may or may not have a permanent effect.