T Nation

28 Y/O Low T Looking for Opinions on Results


#1

Iron 143 (50-175)
Tibc direct 315 (250-450)
Iron saturation % 45% ( 6-36)
Serotonin 262 (50-220)
Total test 233 (241-827)
Prolactin 11.38 (2.10- 17.70)
Bun- 20 (7-18)
Ast 47 (0-37)
Alt 99 (0-65)
Bun/creat 26 (7-25)
Cortisol 29.6 (??)
Tsh 1.35 (.36-3.74)
T3 free 1.77 (2.18-3.98)
T4 free .94 (.76-1.46)
Acth 45 (7-69)
Fsh .9 (1.4 - 18)
Lh 1.6 (1.5-9.3)
24 hr 5hiaa urine 2.1
Creatinine urine 1624 (1000-2500)
Epinephrine/dopamine urine normal
Vasoact intestinal peptide 22 (0-60)

A little about my symptoms: been to two gastros had colo/endoscopy and abdominal ct scan. Bladder slightly distended and 5mm lesion on liver but report said likely a cyst rather than low grade obstruction. Other than that everything normal from ct scan report. No celiacs but did have allergy testing and somehow developed an allergy to rice tomatoes and potatoes in my twenties at some point. Ive lost 38 lbs in the last year and developed seborrheic dermatitis which ive somewhat got under control with antifungals. Ive recently developed facial/neck flushing in the evenings and im worried im getting rosacea. I still get erections periodically but they are nowhere near as strong as a year ago and i have a lot less sperm when i ejaculate. I had t tested from my gp a month ago but it was at 4pm and my total t was lower and my free t percent was really low. Im currently seeing an endo and go in july 5th to discuss results. I hinted at e2 testing but doc seemed to be dismissive. My initial thought was carcinoid syndrome but 5hiaa appears normal. Any feedback is appreciated.


#2

You are located where?

Please describe what is behind the abdominal CT scans etc?

You have secondary hypogonadism. Prolactin is not suppressing LH/FSH. E2 not tested. FT assumed low and then FT–>E2 conversion rate should be low. If serum E2 not low, then liver clearance suspect.

FT not tested.

AST/ALT can be elevated by liver issues, some drugs or sore muscles.

Pleases list all medications.

See last paragraph to evaluate overall thyroid function.
fT3 above mid-range might be suggesting elevated rT3 and if body temps are low, rT3 suspected again.

Skin conditions may improve with TRT.

Find cortisol range and units. Also need time of day and how many hours since waking up.

RBC
hemoglobin
hematocrit
ferritin

Have you used probiotics? Good ones?

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.

KSman is simply a regular member on this site. Nothing more other than highly active.


#3

Im from oklahoma city. I have lost a lot of weight (weighed 159 in april 2016 and weigh 118 now)and had loose stools for about a years time so i went to see a gastro. That first doctor just did a colonoscopy and endoscopy and a few days later told me it must just be ibs and to watch what i eat. I got a metabolic panel done in late feb. And my ast/alt were fine. I went to a derm who gave me fluconazole oral antifungal for seb derm rashes and read that can elevate liver enzymes. I took 150mg once a week for a month through march and it seemed to help my seb derm along with my antifungal cream. In late april i had another metabolic panel and my ast was high end of normal and my alt was 80 (0-41). I havent had an alcohol drink since december and had another metabolic panel done may 24th and my alt was 76 (0-41) without taking any pills or anything that could stress my liver. My second gastro doctor ran the ct scan and some thyroid tests and called to tell me my t3 was low and t4 was high end of normal so he wanted to refer me to endo. Went to see endo in middle of june and had those tests that i posted in my first post done at 740 am only 20 minutes after waking. So for clarity, i have been having stool problems and unexplained weight loss since before my liver was elevated, but my stool problems (diarrhea and loose poop) started after a night of drinking only moderately about a year ago. Im starting to take oral temp every morning and will take it periodically through the day and report here. I will say last april my temp was 97.6 abot twenty minutes after waking at 730 or so when i went to see if i had diabetes. This morning it was 98 even. I will take it at mutiple points throughout the next few days. I have been taking a 25 billion probiotic for three weeks.Thanks foor your time


#4

So ive been taking my temp most days and my morning temp is usually around 97 and I rarely reach 98.6 mid day. I went back to my endo and had some things retested and had a pituitary MRI which came back supposedly showing nothing wrong. following blood test was taken at 7:45 15 minutes after waking up. BTW im 5’8 120 lb and this time last year I was at 150 or so.

Component Your Value Standard Range
Pre 8 AM Cortisol 26.5 ug/dL 8-22 ug/dL
TSH 1.73 uIU/mL 0.36 - 3.74 uIU/mL
T3 Free 1.57 pg/mL 2.18 - 3.98 pg/mL
T4 Free 0.89 ng/dL 0.76 - 1.46 ng/dL
Estradiol Ultrasensitive 12.1 pg/mL 10.0 - 42.0 pg/mL
FSH 0.8 mIU/mL 1.4 - 18.1 mIU/mL
LH 1.3 mIU/mL 1.5 - 9.3 mIU/mL
ACTH 70 pg/mL 7 - 69 pg/mL
Testosterone 192 ng/dL 300 - 1080 ng/dL
SHBG 33 nmol/L 11 - 80 nmol/L
Testosterone Free 33 pg/mL 47 - 244 pg/mL
Testosterone % Free 1.7 % 1.6 - 2.9 %

I was disappointed when my endo sent me a message saying there was seemingly nothing endocrine and pituitary related wrong and she would refer me to a urologist and infectious disease since i have had extreme weight loss. She said she wasnt sure why the cortisol was elevated but could be due to stress or some inflammation in the body (kind of irritating because my cortisol has been high for months). Im considering emailing her back and saying I would like rt3 tested but maybe my urologist can do that tomorrow. Based on what i have read I could be considered subclinical hypothyroid right? I still flush around 3 and it doesnt start calming down until 10 or so before bed. I wake up around 4:30 briefly every morning to urinate then go back to sleep and then wake up at 830 and my face and forehead is really cold non flushed and the process starts over… So in summary, high cortisol, low t3, borderline low t4, low t, somewhat high acth, estradiol seems fine.


#5

Impaired fT4–>fT3 conversion can be from low iron status and depressed ferritin. But your fT4 is well below midrange and iodine issues are important. You have not responded to iodine issues. I have no idea where you got the idea that T4 was high, not listed in your labs.

CBC not listed. Are you anemic?
Serum iron can be misleading as it shifts a lot with recent meals.
Hemoglobin and ferritin are useful labs as well as RBC, hematocrit and total proteins etc. High iron saturation implies that you are not experiencing a GI blood loss with your digesting issues.

Note GI symptoms here: http://www.webmd.com/depression/guide/serotonin-syndrome-causes-symptoms-treatments
Are you taking any anti-depressant medications?

Anti fungal meds can affect LH/FSH and thus lower T levels.

ALT can be elevated by muscle soreness.

You need TRT to stimulate your appetite and combat muscle wasting.

https://livertox.nih.gov/Fluconazole.htm
Hepatotoxicity

Transient mild-to-moderate elevations in serum aminotransferase levels occur in up to 5% of patients treated with fluconazole, but these abnormalities are usually asymptomatic and resolve even with continuation of the medication. ALT elevations above 8 times the upper limit of normal are reported to occur in 1% of patients taking fluconazole and to represent the most common adverse event leading to early discontinuation of treatment. Clinically apparent hepatotoxicity due to fluconazole is rare, but well described. The liver injury is typically hepatocellular, arises within the first few weeks of therapy and can be accompanied by signs of hypersensitivity such as fever, rash and eosinophilia. Fatal instances of fluconazole induced liver injury have been reported (Case 1), but most cases are self-limited, although recovery may be delayed for several weeks after stopping fluconazole and may be slow requiring 2 to 3 months.

fluconazole can create drug interactions by reducing enzyme metabolism of some drugs and can interfere with body functions that depend on certain enzyme pathways.

You have secondary hypogonadism. Prolactin is not the cause. We do see a connection with thyroid status, but that may be cause and effect.