T Nation

24 Y/O: Depression, ADD, Brain Fog, ED Need Help


#1

I’ve recently gone through the most stressful and depressed state of my life due to work/schooling and finally have a bit of a breather to dedicate some time to this.

Burnt out hard around the very end of 2015, was working a high-stress position while attending post-secondary and wasn’t doing either optimally.

Figured it was the job, so I quit to dedicate more time to my studies. The opposite occurred as I spent a few months (almost isolated) at home just scraping doing the minimum to pass my courses.

I knew something was wrong and went to the GP who was clueless and ended up going to a Psychiatrist who specializes in ADD and was later diagnosed with ADD. They ruled out thyroid based on TSH at 1.33, no full panel done.

I have been desperately searching for the root cause of the issues to no avail. Been through an allergist, urologist, sleep clinic and Naturopath and still can’t seem to get any improvement. Many doctors I see try to prescribe some RX after an hour session not understanding the full scope of the issues and are very narrow minded.

Reasons why I suspect hormone issues:

-When I was younger(16-17) and an idiot I had I started a test cycle, only did a couple shots and stopped, was advised to take whole post-cycle bottle of Clomid afterwards. I’m worried that this may have had an effect on my current issues.

-Had gyno that was surgically removed when 17, however have had since very young nothing to do with cycle.

  • ND suggested to do some hormone tests and they came back on the low end for my age

Age: 24
Height: 5’ 8-9"
weight: 145lbs
waist: 32"

describe body and facial hair: Hairy legs, armpits, have chest hair but not very full, cannot grow full beard just neck, mustache, chin, cheeks are sparse.

did to grow fast or slow and steady as a teen: hit growth spurt early, then stagnated

testes ache or hurt? ever? Can’t recall but is possible.

mood: Low, all the time, unmotivated, procrastinating on everything until the last second.
depression: Severe
libido: Rarely now due to performance anxiety. Occasional/mild ED after playing around with various Rx’s, essentially were less full but always had a slight issue with this seems to just be exacerbated by meds. Also after a particular SNRI had some issues with PE but seems to have subsided.

Was there occasionally before but now seems to be more frequent/worse.
get cold easily? a change?: Yes, sensitive to cold, pretty sure I’ve always been.
dry skin, brittle nails?: Yes always have had issues with dry skin/ nails no.
use iodized salt? No, ordered Lugols 2% solution and selenium to start supplementing.
eat much sea food? Moderately
exposure to chemicals?
ever used hair loss drugs? No
Rx and OTC drugs: Yes, Concerta, Vyvanse, Adderall, Stratterra, Wellbutrin, for the past 2 weeks have been on nothing at all.
outer eyebrows: have always been thin on outside, people have made comments them being thin or looking like they have been “done”.

Have been taking oral temperatures sporadically over the past few weeks and can’t seem to get any temperatures in recommended range. Note cheap oral thermometer that varies significantly between readings only a few minutes apart, can’t comment on the accuracy but still concerned I can’t get to posted ranges.

AM: 96.7, 96.9, 96.6, 96.3, 97
3PM: 98.3, 98.3, 97.9, 98

Labs: If ranges aren’t posted it’s because they are unreadable on my copies. Also have many more tests but doubt they will be relevant, can post if needed.

April 2016

TSH: 1.33 0.35-5.00 mIU/L
Ferritin (Iron): 281 ug/L
Glucose Serum Fasting: 5.3 3.6-6.00 mmol/L
Creatinine: 89 umol/L
eGFR: 104ml/min/1.73m*2

14 Hours Fasting:
Cholesterol: **4.84 mmol/L **
Triglycerdies: 0.49 mmol/L
HDL Cholesterol: 2.15 mmol/L
LDL Cholesterol: 2.47 mmol/L

Aug 2016
Hemoglobin: 165 g/l
IgE: 493 ug/L(HIGH)
IgG: 9.4 7.2-16.9 g/L
Deamidated Gliadin IgA: 4.3 U/mL
Transglutaminase IgA AB: 1.0 <10.00 U/ml

Dec 2016:
Vit B12: 314 138-652 pmol/L
Insulin Fasting: 24 20-180 pmol/L
Prolactin: 11.1 4.0-19.0 ug/L

Cortisol 8 AM: 394 135-537 nmol/L
Cortisol PM: 143 135-537 nmol/L

Choriogonadotropin HCG Tumour Marker: <1 <3
Estradiol: 59 <162 pmol/L
DHEA-S: 10.0 <15.0 umol/L

Testosterone: 14.9 8.4-28.8 nmol/L
Testosterone Free: 307 196-636 pmol/L

C Reative Protein: 0.7 <6.0 mg/L
25-Hydroxyvitamin D: 85 75-250nmol/L

I have finally got an endocrinologist referral for tomorrow and based on his online reviews am not expecting much, can you guys please arm me with the tests I will need at this point and what direction I should be looking in?

I know I likely can find much of this information by spending hours going through the forum but my motivation is utterly gone and I am willing to admit I need some hand holding with this. I did make notes on many of the stickies a few weeks back but honestly have forgotten most of it already. I don’t want a band-aid solution, I want to get better but my willpower seems to be dwindling more and more each day.

Thanks in advance for everyone who read/provides input.


#2

Your body temps are low, you were not using iodized salt, eyebrows sparse indicating long term.

See if you can get these tested:
TSH
fT3
fT4 [please not T3, T4]
rT3
With your stress background, you could have elevated rT3 indicating adrenal fatigue from stress.

TSH should be near 1.0, so good there.
Is your thyroid enlarged, lumpy, sore, asymmetrical?
With long term low iodine, TSH could have been high in the past which can lead to thyroid nodules making thyroid hormones outside of TSH control loop and as that progresses, TSH is reduced and that can sometimes progress to hyperthyroidism where TSH is very low. There is a whole spectrum of things that can go on and TSH only good for crude screening that can be misleading in some cases.

You need to find a source of selenium. Get multi-vits that list iodine+selenium

How long were you not using iodized salt?
Why, family did not use?
Other family members affected?
You do not get iodine in restaurant foods or prepared foods.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

#3

After Endo appointment he ordered TSH, fT3, fT4.
(You put in brackets please not T3, T4. However asked for fT3 just above? Just want to make sure not typo can you please advise?)
No rT3 test, will call and ask him to add.

Is your thyroid enlarged, lumpy, sore, asymmetrical?
Endo said it felt fine, doesn’t feel sore.

You need to find a source of selenium. Get multi-vits that list iodine+selenium
Will multi-vit iodine be sufficient? Got lugol’s 2% solution as figured I’m probably iodine deficient as haven’t had any as long as I can remember.

How long were you not using iodized salt?
Can’t remember if we ever did.

Why, family did not use?
Guess we always listened to public opinion that salt is bad.

Other family members affected?
Not showing symptoms.

Will re-read thanks.


#4

lh
fsh
testosterone
estradiol
acth
cortisol
prolactine
dhea-s

do those labs at once
i think you have low lh and fsh, but to find out why, you have to do other test mentioned above


#5

@49perccent
Will see if I can get those signed off on to be covered.

Do you need test, estradiol, dhea-s, prolactin, cortisol again seeing as I just did that work in late December/posted above, or is it important they are done on the same day?

Endo seems to think that hormone levels are all okay yet according to source below It seems I’m way off of the average ranges.

It seems my total test is below that of the average 84 year-old man.
Free Test seems to be around the average for 45-54 year old man.
Endo says I’m in normal range maybe just 25% lower but thinks stress/meds may have caused them to be lower and shouldn’t be concerned. Thinks Gyno due to Prolactin and not sure if test cycle I did when younger had any effect on me.

Can anyone comment on hormone labs posted? Based on this forum they seem low given age (24).

Just had work done for Thyroid should get back soon, wasn’t able to get rT3 just TSH, fT3, fT4 for now, will update post when labs are in.


#6

Update for labs:

Thyroid Stimulating Hormone [TSH]
1.58 0.32-4.00 mIU/L

Thyroxine Free [Free T4]
16 9-19 pmol/L

Triiodothyronine Free [Free T3]
3.9 3.1-6.2 pmol/L


#7

Your problem is probably depression and ADD, which isn’t what you want to hear. :frowning:

Depression and low testosterone share a number of symptoms: Lack of focus, low mood, erectile dysfunction, and loss of libido. They can be related, and there’s a correlation between low free testosterone and depression, but boosting your levels isn’t necessarily going to cure you.

I don’t know if you’ll find a doctor willing to treat you for low testosterone with your levels. Normally they only take into account the total level, and the cut off is typically around 12 nmol/L.

There’s a consensus developing that hypogonadism occurs when the free fraction is below about 225 pmol/L. The upper limit for treatment in this case is somewhere between 250 and 270 pmol/L, and some doctors will treat patients with a normal level of total testosterone who fall into this category. Others will tell you that you’re perfectly fine.

Your levels are above this. It probably wouldn’t hurt to get them checked again, as they can fluctuate. But I wouldn’t be pinning hope on being prescribed TRT, nor do I think that it will cure you.

Here’s the kicker: There is no real cure for a lot of mental illnesses, and you have to learn how to manage the condition.

Is there any reason that you’ve come off your medications? Looking at your timeline, you were diagnosed early last year, and you appear to have gone through four ADD drugs, and at least one or two antidepressants since then.

If you’re as bad as you say you are, then I’d be looking at finding an appropriate drug therapy that works. This can be a process of trial and error, and you might need to vary the dose. If you feel as though you can cope without them, then that’s fine. I came off Zoloft / Sertraline just over a year ago because I didn’t feel a lot of benefit, but suffered the side effects.

You also need to combine the above with some sort of therapy. CBT is very effective at treating depression, I don’t know about dealing with ADD.

Good luck. :slight_smile:


#8

Thank you for your comment, there’s a good chance you’re right but for some reason it doesn’t seem to fit everything I’ve been experiencing. Believe me drug therapy is up next and I’m coming to terms with that but I feel like I owe it to myself to do my due diligence and rule out anything medical before playing around with more pharmaceuticals.

The last antidepressant I was on made me near-suicidal and still don’t feel the same since. I really would prefer to not play roulette until its my only card left.

At this point with the TSH/fT4/fT3 labs posted it seems I am in range for everything.

Free & Total T are low but not low enough for hypogonadism range.
Estrogen seems to be low as well indicating it shouldn’t be the cause for any of this.

Started supplementing with selenium + Iodine (5mg) body temperatures seem to be a higher will start measuring consistently.

Based on stickies:
With TSH/fT4/fT3 we can look at rT3 to look for functional hypothyroidism or possible adrenal fatigue?

Still unexplained: Gyno? (Prolactin in range, no high E2 how could this be caused?)
Carry fat around stomach and buttocks, ED issues, never exuded manliness, always found putting on muscle to be challenge, thin eyebrows, higher than normal pitched voice.


#9

Based on new lab ranges/post is this worth pursuing at this point?

@KSman


#10

Thyroid: Being in range does not really carry much weight by itself.

With low body temps, past iodine deficiency, “thin” eyebrows: You really need to manage the iodine issue and that may take time to have effect. Selenium is very important.

fT3 is below midrange and that explains lower body temperatures.
fT4 is above mid-range suggesting impaired fT4–>fT3 conversion. I am not aware of all possible causes of that, but low ferritin is one cause. However your ferritin is well above what is considered ample for fT4–>fT3 conversion. Pointing out that medications or toxins might be involved has limited value. Maintaining general health may be important and that can involve essential fatty acids and Vit-D3 which I mention because these are readily available and important in any case. The multi-vits with iodine+selenium will work. I see that your Vit-D25 levels are considered very good, so not opportunity there.

Your susceptibility to gyno may just be that in part, making you more vulnerable to hormone imbalances.

Do you have hematocrit labs?
If high, some concern that you might be getting too much iron. Males need to avoid iron fortified food, ditto for vitamins. Iron can be added to flour, bread, pasta, cereals…

Please post how much iodine you are taking and any changes to body temperatures or how alert you feel and energy.

Multi-vits are multi vitamin products that contain a high amount of B vitamins, trace elements and other nutrients.