T Nation

26 Y/O Low T, High Cortisol help


#1

Hello, A little background story I live in Israel and it all begins like that, I was muscular and built for my age till I was 13 or so, Not sure exactly when but around that age or perhaps even beforehand I remember having extremely cold hands, sparse outer eyebrows and constipation. After age 13 I became really skinny. I guess my nutrition was bad or some other undiagnosed illness was the factor. Always used normal table salt, never iodized as far as I know. At age 15.5 I broke my left collarbone and dislocated my right Sternoclavicular joint.

Collarbone healed with a shortening of close to 3cm and this has caused major asymmetry issues and a year later I was diagnosed with mild Scoliosis. I have constant chronic pain since I was 17 and gotten worse each year.
Anyways, I was put on Antidepressants “Fluvoxamine” at the age of 17 or so I believe, as a kid growing up I had a delayed puberty(ADs fault maybe?), I only formed mild Acne at the age of 18 and I only started shaving at the age of 20
I had no body hair at that time, my body hair started growing out at the age of 20, i’m now a full monkey,
my beard is full, and I’m covered by hair in the abdomen, pecs and literally everywhere, It all happened after my growth ended.
It’s like I went through puberty after my growth plate closed or something.

I joined the Army at age 18 and suffered tears in both of my shoulders that were mismanaged.Now it has gotten so bad that I’m having problems lifting the lightest things with my dominant hand.

During the army I didn’t suffer from fatigue, I suffered an H Pylori and an Ulcus. I was treated with Anti Biotics and ever since then I’m having chronic problems with my stomach.
At age 21 it all started to go really bad, Lost 8 kgs of muscle weight and just blamed it on my shoulder and stomach problem.
Now Doctors diagnosed me with “IBS” but that’s total bs, I’m having adverse reactions to carbs, especially sweets. My brain gets foggy, leg pain and i’m unable to concentrate and have to lay down to rest. Done a Gastroscopy and they found gastritis but biospies weren’t taken.
I’m lactose intolerant after I did the hydrogen test and i’m pretty sure i’m intolerant to fructose too cause thatshit fucks up my stomach. My stomach isn’t fond of Gluten either. I get gassy and have to go to the bathroom.

After the army I was put on Cymbalta for my pain and “depression”. Doctor thought I needed a mood stabilizer as well because I was hyper at night(Think it was a side effect of the AD). He put me on Lamictal for a few years.
I was getting the most terrible side effects but I put it all on the stress from the pain I was having.
I was shaky, irritatable, angry, mood swings, itching, night sweats, profuse sweating and hot intolerance and more.
Then the problems with sleep was too much for me so he put me on SEROQUEL! I was a damn zombie sleeping for 14 hours a day. I was gaining weight and stopped it after a month. I felt like this shit was going to make me chronically ill.
I stopped taking Cymbalta and Seroquel cold turkey and it wasn’t the first time I stopped an AD cold turkey. I have done it over the years because my parents didn’t allow me to stop taking the medicines and I was tired of being poisoned.
After stopping the Seroquel I was a different person. Much more fatigued, zombie like…
Right after stopping I asked for blood tests and I remember having a TSH of 3 and high prolactin then after a month or so I asked for more comprehensive tests and I saw the TSH decrease signifciatly so I’m sure the drugs I was taking affected my Thyroid for sure, especially with the side effects I was having for years.

As of right now i’m 6’0 169 pounds, carry most of my fat in the abdomen, lost all definition in my hands.
Extremely sensitive to cold, tend to shiver, heat intolerance,knee and wrist pain, weakness, dry eyes(no tears at all during the day), have no sex drive, no morning wood, no spontaneous erection, weakness in legs, trouble climbing stairs.
Brittle nails, wounds heal slow, trouble recovering from phyiscal activity, brain fog, headaches, sinus problems, heart palpatation at night when laying down, inconsistent high blood pressure, mood swings.
My morning temperature is most of the time around 96.4 and 97.5 in the noon. I’ll check them for few days straight and post them.

I don’t do any phyiscal activity right now because of phyical limitations that I hope i’ll be able to solve soon enough.
My diet is inconsistent and that’s because of my food sensitivites. I started taking selenium and Lugol’s Iodine but it’s making me shiver even more and have even colder hands. Don’t know how to proceed with it.

Here are my blood results since 5/2016 listed in chronological order from oldest to latest: First blood test showed TSH 1.82 mui/L (0.55-5) Prolactin T4 Free 13.9 pmol/L (10-20) TT 12 nmol/L (8.40-28), Prolactin 181.5 miu/L (45-375), LH 2.6 IU/L, FSH 2.6 IU/L Vitamin D 83 nmol/L (range 75-250)

I have had high creatinine for years now, I think since I was first tested in the army at age 18 but was told because I had high mass but now I have no mass at all and it’s still present.






So my Iron is really low but my Ferritin and Transferrin are fine so I have no idea what that means.


After these tests I was referred to an Endo that ordered the following tests: I had a Cortisol of 209.5nmol/L/24(range 38-208), so she asked for ACTH test and redo testosterone and do a Bio-Available t and TSH, FT4, Total T3 (I know, they don’t do FT3) Also she wanted to check my pitituary and ordered a brain MRI. Brain MRI showed significant sinus congestion on all sinuses, no clear pitituary finding, infundibulum leans to the left.
First thyroid “panel” I wish they could do RT3 , FT3 and antibodies but they don’t do that.



Latest thyroid panel

the high range is for the morning and the low is for the evening not sure if it matters but it’s in hebrew.
She told me that it’s high because i’m stressed.

My T crashed here for unknown reason so she asked for more tests!! this stupid idiot wrote that I have primary hypoganadism and wanted to rule out Kallman syndrome (lol), she ordered a GNRH test and HCG test that I don’t have the results for yet.

I have the GNRH test results but not on the computer. Basically my baseline LH was 2.95 and was taken samples after 15 mins and then in 30 min intervals for 90 minutes.
(15) 2.75 (30)18.70 (60) 17.00 (90) 15.50

T Total(0) 3.57 ng/ml (3.00-10.00) stays almost the same after 90 mins.

Bio Available baseline was 1.57 ng/ml (0.60-2.00) and ended at 1.80 ng/ml after 90 mins.
So I have no idea how my bio-available looks good and I feel like shit and how it recovered like that. What is my next course of action? I thought my biggest problem was low T.

I was told I was going to need injections but now it changes everything. Even if I was going for TT, I have absolutely no trust in the doctors here for giving me a proper TRT treatment.

After that test I did a HCG test but I have yet to receive the results one thing is for sure though, I felt pretty damn good for 1.5 days, my digestion was much better, had erections, was interested in girls and had a much clearer view and mind. After 1.5 days I just crashed and my symptoms came back much worse. Terrible headaches and depression stood out, obviously no sex drive aswell. I guess my E2 went skyhigh after 1.5 days after the injection? I wonder if my E2 to T ratio is what causing most of my symptoms.

For a while now I just can’t even function at a basic level and it’s freaking me out.

So what do you guys think?


#2

What were your E2 levels? I can tell you from personal experience, that having super high TT and FT mean nothing if your E2 is not at the right level. My last labs had me OFF THE CHARTS high with TT and FT and I felt bad. Why? E2 was at 8.4.

What is an HCG test? Do they inject HCG into you and see how you react? Your LH and FSH are at the low end, aren’t they? HCG mimics those hormones and tells the testes to produce T so maybe you were feeling better because T production was up?

I’m a noob so take what I say with a grain of salt. It seems like you’ve been doing plenty of reading, but make sure you read the estrogen sticky.


#3

I posted images with all the values, do you see them? my E2 was 106 pmol/L roughly 29 pg/ml in US conversion.
I think it’s a bit high when you compare it to my total T.
I have been doing mostly useless tests imo. The HCG test is they take a Testosterone basline and then inject 5000 IU Pregnyl and take another T sample after 4 hours then have me come for 4 days straight for blood tests to see if my T had gone up. Only felt good for 1.5 days though and now i’m still worse than before.


#4

That is one of the biggest workups I have seen.

Have you seen all of these?
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
  • thyroid basics

fT3 is the active hormone
is stress has messed with adrenals, rT3 may be elevated and blocking fT3

Are you gluten intolerant?

There is a gene that can be defective for fructose, you would need that from both parents. Affects 1 in 10,000, 20,000. There is a gene test. I carry on of those defective genes.

Better to not have total cholesterol lower than 160. Cholesterol is the starting point for the sex hormones, cortisol and Vit-D3.

How are you going to get more iodine?
You need to get selenium as well. A multi-vit that lists iodine+selenium would be good, but should not contain iron.

Serum iron varies a lot with recent meals and is not a useful lab as it swings too much.

E2=80pmol/L is ideal for guys on TRT with high TT, FT
With your low T, you are very estrogen dominant.

Now that you are off of those drugs, you can try to get iodine and body temperatures improved and see if anything in the HPTA restart sticky will work.

If you do TRT, you will need hCG SC 250iu EOD to preserver fertility.


#5

Thanks man, I’m off the drugs since March of 2016. I’m very up and down.
I realized I was estrogen dominant… I wonder how it’s going to effect my treatment since HCG raises E2 quite considerably.

My Total T is still low but my Bio-Available T is higher than mid range. Does that mean I have low SHBG?
My albumin is high so how does that affect my SHBG or T?
Having low total t and higher bio t means I also have high bio availble e2? what are my treatment options if there are any at all? I’m not sure the doctors here are likely to treat me while having higher than mid range levels of BA-T.

Yes, I read everything in the stickies. I’m sure RT3 is elevated but I can not check it in my current health system it seems. I’m afraid to take Iodine in big amounts, since I really don’t have a full thryoid panel and I know my symptoms match a thyroid issue but my TSH is fine. I’m currently taking 200 mcg selenium and two drops of Lugols 3% but can’t stick to to the Iodine because of fear. Do you know if Iodine deficiency is common in the middle east?

I checked for celiac antibodies and I was fine last time I checked. I think i’m going to pay 400$ out of my pocket to get a comprehensive digestive readings and check for Leaky gut, Gluten intolerance, Sibo etc.
Cause everytime I eat something sweat it just affects me badly.

I have no idea why my HDL is so low and why my Trig was got so high since the test before that. My diet really isn’t optimal but like I said, that’s mostly because of my food sensitivites.
I only started having fructose and Lactose intolerance after I finished the army and used Anti-biotics so it might be bad gut flora or some other shit, so it definately wasn’t from birth. I believe something else is causing this.
I wonder why everytime I eat something seat with high carbs I just crash and get highly fatigued… does that have anything to do with insulin resistance eventhough my Glucose is in range albeit is elevated since the last test.
What do you think of my ACTH test? are you familiar with it? wasn’t the cortisol supposed to rise much higher after the ACTH admission? I wonder if my adrenals are functioning normally.

Thanks a lot man…


#6

@KSman Please respond to my latest post when you are free, thank you


#7

In many cases, hCG increases T and E2 increases simply as expected from increased T.
Large doses of hCG create problems.
A few/rare have a strong increase of E2 from low dose hCG. Some freely convert oral DHEA to E2. There are always some guys who do not fit the pattern.

I did note the ATCH issue and though that this might be a stress reaction to the blood draw experience. ATCH and cortisol seemed self consistent.

Yes, low SHBG is implied.

more albumin leads to more albumin+T which supports higher bio-T

While SHBG+T is not bio-available, SHBG+E2 is weakly bound, so your thinking on this needs some adjustment.

Iodine deficiency is almost universal and 100 years ago goiter and mental retardation were very wide spread afflictions. Even if one did not exibit these issues, lethargy was the norm.

https://www.google.com/search?q=iodine+deficiency+in+middle+east
You need to consider how things used to be without iodized salt and decide which side of the fence you want to be on.

"Cause every time I eat something sweet it just affects me badly."
Try taking Benadryl 40 minutes before a meal and if things are easier, you will know that part of your problem is histamine related. https://en.wikipedia.org/wiki/Diphenhydramine

Note that the gut has different histamines than your body and you can also experiment with https://en.wikipedia.org/wiki/Ranitidine

You should be trying a good probiotic and take with meals for a month to see if gut improves?
Are you crampy, constipated or loose?
Farts smell horrible?
This can straighten out a lot of problems: https://en.wikipedia.org/wiki/Bismuth_subsalicylate
And might be something to try first. Note that is expected to make your shit look black, so don’t worry about that.

Your hCG 5000iu injection was stupid. If you self injected 250iu hCG EOD you would probably feel decent on that.


#8

@KSman Thanks a lot man. This stupid endo wanted to do that HCG test. couple days later I was almost suicidal. That’s insane.
I’m not sure my Bio-T is really high tbh, the range of 0.60-2.00 is ng/ml is ridiciously low narrow right?
I have seen 1.30-6.80 on the net as the proper range.
Anyways i’m not even sure I want to have TRT replacement here in Israel. I’m probably going to be administred an injection of 200mg once every 3 weeks or a Gel so it’s going to be suboptimal and that’s a damn shame cause I really can’t function like that.

What are the chances I have an insulin resistance and or hypoglcemia if my glucose is within range? feeling lethargy and weakness after eatings sweets is worrying to me.
We have a my father, my uncle and my grandfather all have type 1 diabetes so I might be predisposed.

I’m going to try an antihistamine. Not sure there is Benedryl here so i’m going to check for an alternative.

Farts do smell horrible. I was always constipated as a child and thought it was normal at the time. Now i’m never constipated only loose. Rarely do I have cramps but I’m always gassy.

Do you have any recommendation for a good probiotic? Thank you.


#9

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83686

TESTOSTERONE, BIOAVAILABLE
20-29 years: 83-257 ng/dL

Some lab ranges do not travel across different lab companies.

I cannot recommend a probiotic that you would find there.
This is a good product: http://www.renewlife.com/ultimate-flora-probiotics.html
Many probiotics are useless.

Please try the bismuth subsalicyate first as that may be available.


#10

@KSman Hello, so i’m at the end of my rope here. My Endocrinolgist is stupid and I don’t know how to proceed from here.
I met with her and she told my problems are not the result of low T since my Bio-available is higher than midrange 1.5 ng/ml (range 0.60-2.0).
My Total T on the last test was 3.2 ng/ml range (3-10).

I told her that after the HcG she put me through I felt great for 1.5 days and then I totally crashed. She showed me that after 4 days my bio-available T was 3.4 (range 0.6-2.0) and so my problems can’t possibly be from low testosterone(since I felt like shit after 4 days). I told her that I might have felt like shit because of the increase in estrogen (which already had bad ratio before the test). She told me that estrogen has nothing to do with bio-T and since it came out more than fine i’m all good.

I have every symptoms of low T… what drives me crazy though is how I react to sweets, like cakes and such.
I get itchy, brain fogged, tired and get numbness and weakness in legs etc… My fasting blood sugar is normal so I have no idea what this is. I can’t find anywhere to buy bismuth or Benadryl.

Anyways she told me since my T is fine, she wants me to check why my ACTH is high so he wants me to do a 24hr cortisol urine test along with a midnight saliva test. I don’t expect anything out of it and i’m not sure I should follow through.

She probably expects the tests to be normal so she could classify me as depressive. After the “normal” blood tests she was implying that I might suffer from depression and that’s why I feel how I feel and that’s bs.

I want to ditch her but I have no alternatives and no idea what to do.

What do you think?


#11

@KSman
Did the HCG Test of 5000IU shut down my LH/FSH? is that possible?
I feel worse in every way since that test. Or 1 shot of HCG isn’t enough to shut down?


#12

I guess you are dead then.


#13

5000iu hCG probably spiked T–>E2 production in your testes, then T levels dropped after a few days and serum E2 lingered shutting you down. But you should recover from that.

If LH has been low, hCG can only work with what the testes can manage. Should have been 250iu SC EOD self injected, 5,000iu lasting 40 days. Then the testes can respond physically and produce whatever they are capable off. If T levels are good then, that is your therapy. Use insulin needles and inject SC, not IM.

Look at stomach meds on the shelf for ones that contain bismuth, talk to pharmacist too.

Thyroid:

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

Many countries put up ridiculous barriers to TRT.


#14

There was a local article here that Israel was almost dead last in Iodine consumption. There is just no regulation of Iodine in foods here.
2nd problem is my SHBG… I think i’m predisposed to diabetes or something. My father has diabetes and he is skinny, my hunt and both of my grandparents do but it started very late in their lifes.

Thing is, I’m pretty sure i have some kind of insulin resistance right now, I developed a little tummy so i’m skinny fat and beforehand I was ripped.
It’s jut everytime I eat sweets like chocolate I just crush. Instantly. It’s very frightening to me.

Also, I know that with low SHBG you need frequent injections like E3D or even less and even getting an injection every 3 weeks here is a hassle. I feel like there is no hope to get proper treatment here and it’s a lost cause basically. Am I just destined to live in such a suboptimal life quality?

I wake up every mornin feeling exhausted, tired legs and i’m now going to get a home sleep study done. I doubt if it’s going to be useful for me. Should do a more comprehensive sleep study at a lab.

Anyways, I’m in a very bad place with very limited options. I just don’t want to stick with the doctors here tbh with you… they are just pointing out to depression and want me to do a Cushing’s blood tests to rule that out but I’m tired of these useless blood tests.