34, HighE2, THYROID, LowT, High Cortisol, Major Fatigue, Loss Motivation, ED

Pharma / TRT Testosterone Replacement
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[EDITED/SHORTENED] I’m looking for some guidance on this as I’ve been reading through a ton of posts here for the past week and I am sincerely grateful for all the stories, advice, and support you gentlemen have to offer here…

Age - 34
Height - 5’ 8.5” at most recent dr. visit, swear I was taller when I was younger
Waist - 36-38
Weight - 206 about 25% estimated BF
Hair - on chest, stomach, back, legs and butt, full facial beard capabilities. Hair on upper body slowly filled in late 20s
Carry fat - on the midsection from the nips down to the butt crack. Was chubby during grades 9-10 slimmed down during grades 11-12 and most of 20-30s but never was ripped or “athletic” looking despite a very active/athletic lifestyle. Heavy midsection fat increase end of 2011 and unable to remove it still to this day despite clean diet and consistent training.

Rx Meds/Hair Meds: Used generic minoxidil products for about 1 year around 2004-06 and then stopped, never used oral meds for hair. The baldness has progressed slowly but I just shave it all off now and have for the past 6 years. Currently no Rx meds. Used generic provigil/modafinil (modalert 200) recently, purchased online and started around beginning of April 2016 in an attempt to remedy fatigue but it was inconsistent so I stopped.

Training - started Crossfit 8 months ago and scaled slowly to a now consistent 4-6 days per week 60-75 mins per workout. If I stop training for even a week or 2 I regress pretty bad physically feeling weak and jiggly…

Testes ache? - NO

Morning wood - I didn’t even notice it had declined so substantially until I started researching TRT and revisiting my past memories to realize that my morning wood is NOT what it used to be. Rare urges for sex.

Diet - NO iodized salt. 2000-3000 calories per day mostly organic foods, lean proteins 180-220g protein daily, vegetables, some fruits, low GI carbs, good fats. Mid-March I felt plateaued and hadn’t been improving for the previous 2 months so started this Herbalife shake deal which is basically 2 protein shakes/day along with vitamins and 2 solid meals per day being sure to eat 150g+ lean protein daily.

Past 9 days I haven’t worked out nor taken workout supplements besides vitamins listed below…

Vitamins:
MultiVitamin by Herbalife, take 1x3 daily, Iodine 50mcg, Selenium 17mcg
Cell Activator by Herbalife, take 1x2 daily, Alpha lipoic acid 150mg, Aloe Vera, shitake mushroom, pomegranate rind, pine bark extract, rhodiola root
Omega-3, take 4 daily, 500EPA/250DHA each pill
D3, take 1x2 daily, 2000iu each
Glucosamine/Chondroitin/MSM, take 1x3 daily, originally helped relieve some major shoulder pains and my joints hurt if I miss these, even after not working out for 9 days.
BodyMint, 1x2 daily, Cholorophyllin

Supplements pre/post workouts:
Creatine powder 5g/day (was taking daily after load)
BCAA purple wraath 2 scoop/day (1 scoop pre, 1 scoop post w/o)
Naked pea protein 26-52g/day

Symptoms…

Fatigue - major fatigue lately and progressed significantly over the past year. I almost didn’t notice it till I realized I had been trying to remedy with coffee then generic provigil. Then about a week prior to this post it hit me, unable to do anything.

Lack of motivation - typically a very driven person now just feeling down in the dumps, antisocial, not excited to go out and accomplish my goals.

Extreme difficulty putting on muscle, easily put on fat. If I don’t work out, I’ll get fat very quickly no matter how clean I eat or how much I count my calories. Difficult recoveries from workouts.

Lower sexual libido - see morning wood above

Trouble sleeping well - I’m hot when I fall asleep and cold in the early morning (my woman is exact opposite), check my body temps below

Perspiration - I sweat more than normal. Sweat in my sleep. Sweat very quickly in the warm up at CF

Urinate frequently - I urinate way more often than I feel I should, seeming like after every time I take a drink. I drink at least a gallon of water per day.

Feeling bloated - I’m not as gassy/farty as I used to be, probably because of the cleaner diet, but still feel bloated and fater than usual at times. This is in addition to my on/off jigglyness.

Sensitivity to chemicals - I can feel it when I eat something that has MSG. Also can feel my body become inflamed if I eat dirt food like pizza/ice cream.

Elevated blood pressure: I donate blood around 4-6 times per year so I get readings of my BP and at one point about a year ago I was reading 135/95 which is moderate hypertension but at the same time I was eating a very clean diet and exercising lightly but was still overweight. It wasn’t until I started exercising heavily that my blood pressure then went down to 120/82 with my most recent reading at 124/86 on 6/15.

I’m a regular blood donor (but missed my last donation, got one next week) and notice that my body temp has always been low like 96/97, can’t ever remember a 98.

Body temp:
6/14 mid afternoon 200pm - 97.3
6/14 mid night 730pm - 97.4

6/15 waking 630am - 96.9
6/15 mid afternoon 130pm - 97.3

6/16 waking 615am - 96.2 (woke with headache felt like a hangover, I don’t drink)
6/16 morning 930am - 96.9

Labs below from 6/9/2016:

TESTOSTERONE, TOTAL 480 ng/dL (250 to 1100) QuestDiag
TESTOSTERONE, FREE 98.0 pg/mL (35.0 to 155.0) QuestDiag
ESTRADIOL 48.8 pg/ml (0 - 56 pg/ml)

TSH 3.21 uIU/ml (0.55 - 4.78 uIU/ml)

WBC, AUTO 7.2 K/ul (4.8 - 10.8 K/ul)
RBC, AUTO 6.27 M/ul (4.15 - 6.10 M/ul)
HGB, AUTO 16.2 gm/dl (12.5 - 18.0 gm/dl)
HCT, AUTO 48.8 % (37.5 - 52.0 %)
MCV 77.8 FL (80 - 99 FL)
MCHC 33.2 gm/dl (32 - 36 gm/dl)
RDW, RBC 13.0 % (0.0 - 14.5 %)
PLATELETS, AUTO 292 K/uL (130 - 440 K/uL)
DIFF METHOD AUTOMATED
NEUTROPHILS, AUTO 3.3 / 45.3% K/ul (1.8 - 8 K/ul)
LYMPHS, AUTO 3.2 / 45.0% K/ul (1 - 6 K/ul)
MONOCYTES, AUTO 0.5 / 7.6% K/ul (0.0 - 0.80 K/ul)
EOSINOPHIL, AUTO 0.1 / 1.8% K/ul (0.0 - 0.65 K/ul)
BASOPHILS, AUTO 0.0 / 0.3% K/ul (0.0 - 0.20 K/ul)

CHOL 191 mg/dl (<200 mg/dl)
TRIGLYCERIDE 65 mg/dl (<200 mg/dl)
HDL 49 mg/dl (>34 mg/dl)
CHOL/HDL 3.9
VLDL, CALC 13 mg/dl (0 - 40 mg/dl)
LDL, CALCULATED 129 mg/dl 1 (0 - 129 mg/dl)

HGB A1C %, HPLC 5.4 % (<5.7 % normal)
GLUCOSE, FASTING 96 mg/dl (70 - 99 mg/dl)
CREATININE 1.05 mg/dl (0.50 - 1.20 mg/dl)

PROTEIN, UR, QUANT 16 mg/dl (<10 mg/dl)
CREATININE, UR 207 mg/dl
PROTEIN/CREATININE RATIO 0.1

CALCIUM 9.6 mg/dl (8.7 - 10.0 mg/dl)
BUN 15 mg/dl (8 - 20 mg/dl)
VITAMIN B12 851 pg/ml (180 - 914 pg/ml)
FOLATE >22.0 ng/ml (>4.0 ng/ml)
SODIUM 139 mmol/L (135 - 145 mmol/L)
POTASSIUM 4.4 mmol/L (3.5 - 5.3 mmol/L)
CL 104 mmol/L (98 - 108 mmol/L)
CO2 26 mmol/L (22 - 32 mmol/L)
VIT D,25-HYDROXY 58 ng/ml (30 - 100 ng/ml)

AST 40 U/L (11 - 41 U/L)
ALT 58 U/L (5 - 63 U/L)
ALK PHOS 70 U/L )20 - 126 U/L)

Urinalysis:
APPEARANCE, UA YELLOW CLEAR
SP. GRAVITY, UA 1.010 (1.005 - 1.030)
PH, UA 7.0
LEUKO. ESTERASE, UA 0 0
NITRITE, UA 0 0
PROTEIN, UA 0 0
GLUCOSE, UA 0 GM% 0 GM%
KETONE, UA 0 0
UROBILINOGEN, UA NORMAL MG/DL <4 MG/DL
BILIRUBIN, UA 0 0
HGB, UA 0 0

I have Kaiser medical.

4/2016 - initially met with my PCP in about the fatigue and attempted to get a Provigil Rx but he instead he Rx’d me sleeping pills which I didn’t fill because I didn’t need more sleep, need more energy. Instead I just bought the provigil online and it was helpful but didn’t help much.

6/8 - the day after my major fatigue crash I saw PCP again and told him about my symptoms and asked him if it could be Testosterone related he said maybe but it’s not common but he ordered the above tests anyways since it’s been years since I’ve seen a doctor. Over the next 5 days I received the results and dug into them with pubmeds and posts here and elsewhere online.

6/14 - I emailed PCP stating that my E2 is way high for my age (referencing a study), my TSH is high (referencing AACE recommendation range change in 2002), my TT is in the range of a 75 year old (ref 1996 study), and although my FT is okay it could be moot because of my high E2 levels.

6/15 - did an early AM phone appt with PCP who told me my labs are in normal range so all good but referred me to the Endo to answer my concerns from my email.

6/15 - pulled a rabbit out of my hat and managed to book a late AM appt with the Endo. I shared my symptoms and E2, TSH, TT, FT lab concerns. DOC could give me AI to help lower my E2 but doesn’t think it will make a difference in my quality of life. If I was at 380 TT DOC might consider TRT but I’m at 480.

DOC thinks my symptoms may be iron deficiency, wants to to check cortisol (24 hours of urine), orders more labs and some to be redone. Also mentioned possible sleep study for sleep apnea (I used to sleep fine last year and I don’t snore). I got a feeling DOC is opened to patients being active in their health care so I asked if I could email a list of tests to add to my lab order and the answer was yes so long as they’re not crazy. I emailed 8 tests to add, DOC replied that not all of those I requested are clinically relevant to me so did NOT add rT3, Progesterone, PSA, CoQ10, to my lab order.

6/16 - blood drawn
6/17 - 24 urine testing all day

Below are new and repeat labs coming over the next week:

FREE T4
IRON PROFILE
LUTEINIZING HORMONE
ANTI-MICROSCOMAL AB (ANTI-TPO)
PROLACTIN
THYROGLOBULIN AB
TSH
T3, FREE, TRACER DIALYSIS
DHEA SULFATE
DIHYDROTESTOSTERONE
PREGNENOLONE
SHBG
HGB
HCT
ESTRADIOL
FERRITIN
FSH
CORTISOL FREE 24 HOUR URINE

I’ve read all the recommended stickies (super informative gents, nicely done!) and upon KSman’s suggestion I’m now looking for a high potency Iodine supplement to begin after my 24 hour urine deal. My multi-vit already contains iodine and selenium but perhaps not enough.

I’ll add the lab results in as I receive them, however in the mean time do you have any suggestions?

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UPDATE 6/17: Received some labs, a email from Doc with Rx, and then more labs. I’m a little concerned about Doc’s pulling the trigger on the Rx so quickly without seeing all the labs so I email replied asking for details.

Interesting to note… After about 9 days in a heavy rut with fatigue, no motivation, super social withdraw, I felt better yesterday 6/16 day of the labs below and today 6/17 feeling even better.

FERRITIN 43.2 ng/ml (22 - 322 ng/ml)
T4, FREE 1.3 ng/dl (0.9 - 1.8 ng/dl)
HGB, AUTO 15.9 gm/dl (12.5 - 18.0 gm/dl)
HCT, AUTO 48.8 % (37.5 - 52.0 %)
TSH 3.05 uIU/ml (0.55 - 4.78 uIU/ml)
DHEA-S 154 ug/dl (110 - 370 ug/dl)

DOC: I have reviewed your results , I recommend you to start the thyroid hormone, 25 mcg daily. Please take your levothyroxine regularly in the morning, fasting, no food for 30 minutes, and avoid multivitamins, iron, calcium and soy for at least 4 hours afterward. You will need repeat blood work in 2 months. If you get palpitations please email me. Rest of your blood work is still pending.

ME: What is my diagnosis exactly? Can you please explain how the text results point to this diagnosis as well as how the levothyroxine will remedy the issue?

FSH 1.8 mIU/ml (0.7-11.1 mIU/ml)
LH 1.4 mIU/ml (0.8-7.6 mIU/ml)
ESTRADIOL 44.1 pg/ml (0 - 56 pg/m)

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UPDATE 6/18: Begin iodine replacement started 50mg IR at 25mg 2xED, 2-4 brazilnutz/day for selenium, celtic sea salt 10g/day to help remove bromine, adding Vitamin C - 2000-5000mgs/day, magnesium - 400mgs/day, doubling vitamin D from prior 4000iu/day

Temps were weird today: 95.2 at 11am tested repeatedly about 7 more times and it slowly moved up to 97.4, need new thermometer.

Constant salty taste in the mouth, feeling a slight high immediately after taking 2nd round of 25mg IR at 230pm, first was taken at 730am.

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Bro I’d kill for your Natural levels & energy. 9 days of fatigue is a drop in the ocean on this forum, and good you are coming back to your old self. Try living life with Total T of 39 like me and you will appreciate your own more!

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Thanks @trtlabrat, and I hear you, my T levels are higher than many others here but something in my endocrine system is still definitely negatively effecting my life. I’m on the IR protocol recommended by KSman and it has had a very quick positive effect for me and new test results have me headed in different direction toward the adrenals.

I’m grateful for the bout of severe fatigue because it was just the wake up call I needed to help me recognize that my performance has been seriously deteriorating over the past year or so. I’ve been studying this stuff, taking notes every day regarding tests, recording temps, how I’m feeling, etc… and I’ll update this thread here to serve as a documentary of my case.

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6/17 UPDATE:

FERRITIN 43.2 ng/ml (22 - 322 ng/ml)
T4, FREE 1.3 ng/dl (0.9 - 1.8 ng/dl)
HGB, AUTO 15.9 gm/dl (12.5 - 18.0 gm/dl)
HCT, AUTO 48.8 % (37.5 - 52.0 %)
TSH 3.05 uIU/ml (0.55 - 4.78 uIU/ml)
DHEA-S 154 ug/dl (110 - 370 ug/dl)

DOC reviewed my results thus far and recommended me levothyroxine hormone, 25 mcg daily and repeat bloodwork in 2 months. I asked what is my diagnosis exactly and to please explain how the text results point to this diagnosis as well as how the levothyroxine will remedy the issue.

FSH 1.8 mIU/ml (0.7-11.1 mIU/ml)
LH 1.4 mIU/ml (0.8-7.6 mIU/ml)
ESTRADIOL 44.1 pg/ml (0 - 56 pg/ml)

6/17 - 9am Tems: 97.4/96.8/97.4
6/17 - 1pm Temps: 98.2/97.8/97.9

Performance wise on a scale of 1-10, 10 being highest, I’m feeling like a 2.

6/18 UPDATE:

800AM trned in 24hr urine, started 50mg IR at 25mg 2xED, 2 brazilnutz/day for selenium, and also adding 5-10g celtic sea salt, 4000-8000 vitamin C daily, vitamin B complex, Magnesium 400x1, calcium 800x2. Picked up some good stuff here: jeffreydachmd.com/wp-content/uploads/2014/03/The-Guide-to-Supplementing-with-Iodine-Stephanie-Burst-ND.pdf

6/18 - Mid-day temps: 95.2 tested repeatedly about 7 times up to 97.4, need new thermo

6/18 PM email from DOC said that although my thyroid levels are normal but there is some room for a small dose of levothyroxine to see if it may help with fatigue. DOC doesn’t think the reason for my fatigue is the thyroid but ordered the meds anyways.

While I was surprised for such a quick diagnosis and Rx, I quickly realized that after all the nightmare stories I’ve read on this forum and elsewhere online that this type of trigger happy diagnosis and treatment is rampant in health care.

Will wait for other test results before deciding on taking thyroid Rx.

NOTE: always ask for clarity and details in regards to DOCs diagnosis and treatment, especially if they’re handed out so liberally without full diagnostic testing. Double check diagnosis, treatment, and test results for yourself. Read way too many stories of guys blindly listening to DOCs, starting a treatment without full diagnostics, and then f**king up their system which makes it much harder to nail down the source of the issue.

DOC is headed on a 2 week vacation this week so I replied with a pitch for an AI Rx since my E2 levels are also not out of range but high, just like my thyroid labs, DOC replied on 6/22.

PROLACTIN 6.4 ng/ml (2.1 - 17.7 ng/ml)

6/20 UPDATE:

SHBG 21 nmol/L (10 to 50)

6/20 - 1pm temp = 97.4/97.3 (using thermo 1, original)
6/20 - 1pm temp = 98.4/98.6/99.1 (using thermo 2, new)

6/20 - 530pm temp = 97.4/97.9 (using thermo 1, original)
6/20 - 530pm temp = 98.7/98.9 (using thermo 2, new)

6/20 end of day… feeling excellent, body feels tight, strong, mind feels clear and focused. Feeling the motivation to work out again and crush it in business. Libido is BACK! Morning session and late night.

Performance wise on a scale of 1-10, 10 being highest, I’m feeling like a 5.

6/21 UPDATE:

6/21 - 800am temp = 98.1/98.1/98.3 (using thermo 1, original)
6/21 - 800am temp = 98.3/98.5 (using thermo 2, new)

6/21 - first work out in roughly 3 weeks was tough but I did okay.

Performance wise on a scale of 1-10, 10 being highest, I’m feeling like a 4

TPO AB - NEGATIVE
THYROGLOBULIN AB - NEGATIVE

6/22 UPDATE:

AM - Body feeling warmer than usual almost like a slight sunburn, energy ok, focus good, motivation good, back to getting some shit done, feeling more confident, morning wood. Poop is more solid like fibrous rather than the inconsistent and sometimes watery splatter shits that I often have. Maybe I previously had digestion/absorption issues, could be an area to explore in future. Performance wise on a scale of 1-10, 10 being highest, I’m feeling like a 4.

Message from DOC in reply for my request for AI Rx:

“For further work up of the fatigue you will need to contact PCP. Endocrine wise there is no abnormality so far. Your estradiol level is within the normal range and it would not make any clinical difference to bring the level down.” I replied 6/23.

DIHYDROTESTOSTERONE 35 (16 to 79)

PM - ater afternoon very tired and slow like pre-iodine days. Slept early like 930pm. Performance wise on a scale of 1-10, 10 being highest, I’m feeling like a 3.

6/23 UPDATE:

6/23 - 630am temp = 96.9/97.1 (using thermo 1, original)
6/23 - 630am temp = 97.3/97.4 (using thermo 2, new)

Email to DOC…

“DOC I’m going to pretend that I didn’t see that last message where you brushed off my situation as sub-clinical and sent me back to my PCP without receiving all of my test results. Even as I write this message we’re still waiting for my iron profile, pregnenolone, TT&FT, results so please do not close the door on me. I just looked at my 24 hour cortisol result & this is way HIGH. I’d like to get further testing done to determine the source of this:

adrenocorticotropic hormone (ATCH)
corticotropin-releasing hormone (CRH)
MRI hypothalamus and pituitary area to rule out pituitary adenoma
MRI adrenal glands to rule out adrenal adenoma
Whatever test you have to rule out adrenal hyperplasia
As well as any other test you recommend”

6/23 Test results…

CORTISOL/CREAT, UR, QUANT 71.1 (4.0 to 50.0) Unit: mcg/24 h
T3, FREE 230pg/dL (210 to 440)
T3 99ng/dL (76 to 181)
TESTOSTERONE, TOTAL 454 ng/dL (250 to 1100)
TESTOSTERONE, FREE 83.7 pg/mL (35.0 to 155.0)

High cortisol so I’m going to chase this lead as far as I can. It has me concerned about possible pituitary adenoma, could also lead to adrenal fatigue. Possible solution could be TRT as per this study shows that TRT helped lower/regulate cortisol levels in men: Testosterone Suppression of CRH-stimulated Cortisol in Men - PMC “in contrast, our data demonstrate that the effect of testosterone in young men is to inhibit rather than augment the cortisol response to CRH stimulation.” As per this article: peaktestosterone.com/Testosterone_Adrenal.aspx Could also be high cortisol causing all hormone receptors to decrease sensitivity.

My symptoms correlating to high cortisol include: fatigue, loss of motivation, bad sleep, difficulty falling asleep, difficulty building muscle, muscle weakness, easily stores fat on midsection, decreased libido, cognitive difficulty, new high blood pressure, problems with digestion, and cravings for unhealthy foods which is interesting because the past year I can clearly remember that when I hit an obstacle in building my business and experience stress I’d crave pizza and ice cream. Apparently this results from stress increasing cortisol which messes with your blood sugar.

DOC reply to my message:

“I have seen your 24 hour cortisol result, it is slightly elevated, we will test this further but CRH is not the tests for this. We do dynamic testing to check for cortisol excess. This level of elevation can also be seen with stress and obesity. We will also order an 8 am cortisol and ACTH. We do not do any imaging until we confirm the cortisol excess biochemically. You need to to an overnight dexamethasone suppression test”

DOC basically said we need to double check my Cortisol test result before we move to those other tests.

Messaged DOC ruling out stress and obesity. The past 6 months has been one of the lowest stress periods of my life. My nutrition and exercise program have been extremely focused and results have been incredibly difficult.

I will do ACTH + cortisol blood test next day and then a week later overnight dexamethasone suppression with a repeat ACTH + cortisol test that morning.

Performance wise on a scale of 1-10, 10 being highest, feeling like a 3, which is down compared to 6/20 - 6/21, perhaps it was the honeymoon period after starting IR?

Donated blood at noon, blood pressure 122/95, holy sh*t!

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I think it’s a very dangerous game thinking numbers actually mean anything other than supporting symptoms. Yes, yours are the lowest number I have ever seen. But I was at TT=600 but didn’t have energy to move around and had once a year kind of libido. My FT was low due to high SHBG but this is to suggest that do not say you’d like to have a higher but still low levels. It won’t probably do anything for you. You can be hypogonadal at 1ng/dl and like me at 600. Symptoms decide if you’re hypogonadal, if you are being at 100 or 400 does not make a difference in your symptoms.

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The free testosterone range is very low on your lab. I know what people say about ranges but I have found it to be inaccurate. Most lab ranges for free testosterone is 4.5-30.4 pg/ml and some 9.3-30.4 pg/ml. Yours caps at 15 pg/ml. There have been many men’s health and endocrine society papers suggesting replacement therapy in people with ft less than 8 pg/ml. So you’re close.

Your thyroid was a problem and you’re fixing it. If you don’t feel any better, looking at your LH and FSH, you could get a decent boost with using arimidex 1mg/week in EOD doses.

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@equalo212 holy sh*t your symptoms were revealed at 600TT, wow! Good to hear, not good that you had symptoms at that level, but good to hear in I’m glad you shared your experience as it makes me feel better, like I’m not chasing a ghost in relating my symptoms to low T.

I’m kinda confused about you saying my numbers being the lowest numbers you’ve ever seen as mine aren’t that low but maybe I just misread.

Anyways, are you saying that arimidex would lower E2 and would also help increase my LH and FSH levels?

Thanks!

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The previous post was a reply to another poster. I did not know my baseline and ran clomid for a month and the test was done 3 months after that. TT does not mean anything, TT is comprised of T bound by SHBG, free T and T bound to albumin. T bound to SHBG is not bio available. So if it’s no bio available it’s of no use. So clomid may have increased TT but also got by SHBG way over the top of the range and FT was like yours. Sometimes lower, sometimes a bit higher. I have had symptoms for 4 years now.

This is not to say that TT is not useful, but can be misleading in some cases like mine. And I was trying to point that a disease is not a competition as to who got a higher degree of it. If a particular number is low FOR YOU, you will feel like crap. Hormones are tricky and that’s why problems are underdiagnosed as doctors can only see the big cases , i.e, completely out of range. In the end, it is important to understand you’re not treating your numbers, some people don’t have problems with low T as these guys are genetically meant to function at lower levels and don’t have libido, energy and mood issues. So if you treat these guys with TRT and leave out others, it’s not good practice. That’s why symptoms rule, labs support.

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Thanks for clarifying @equalo212 and again thank you for sharing your experience as it really helps to affirm my posture with the DOC telling me “at your levels there will be no clinical improvement… blah blah blah”.

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So thyroid is a mess and you never used iodized salt. Can you fix that for future. Anyone else in your living unit also iodine deficient?

fT3 is well below mid-range. Is that pre T4 medication?
fT3 is what gets the job done.

Ferritin should be 80 or above to support efficient T4–>T3 conversion.
Has your diet been lacking red meat?

Cortisol: Cortisol is progesterone–>cortisol. You can look to see if progesterone is elevated - for a male.

You cannot get anywhere with adrenal fatigue issue without rT3.

Try 0.5mg anastrozole per week in divided doses. You need to control E2.

E2 and hypothyroidism can contribute to low LH/FSH.

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I appreciate the input @KSman!

You’re right, my thyroid is a mess and now after all the research I’ve done here and elsewhere online, I think it has been messed up for the past few years so right now my focus is on fixing my thyroid. I’ll include my current thyroid protocol at the bottom of this post but first respond to your questions…

Definitely implementing your IR protocol going forward. I started about 3 weeks ago with 50mg Iodine/Iodide pills I found at a natural food store here + selenium and it got me up from feeling like a 1/10 performance to around 3/10 in the first few days, great stuff!

Also been testing my wife’s temps and she’s been low 97s, even some 96s, so she got started on a 12.5mg/day IR about a week ago. Her temps are rising and she has noticed the boost in energy. Going to move her up to 25mg/day maybe in a few weeks because she’s breast feeding.

The fT3 and all above test results are pre T4 meds. I didn’t start the T4 when the endo gave it to me because I wanted to make sure it was the right treatment and also didn’t want it to throw off any other tests I might have done.

It’s strange that my Ferritin was so low because my diet has not been lacking red meat but I have since started iron supplement 65mg 2x/day to start.

My Endo denied my earlier progesterone test request which was strange because they accepted my request to test pregnenolone and DHEA-S and most of the other hormones in the cascade.

I’m going to push hard for the rT3 test on the next round of tests in about 4 weeks and perhaps consider the AI if my E2 levels are still high at that time but for now focusing on the thyroid.

My Endo had suggested a Dexamethasone Suppression Test to double check my cortisol, results are below:

6/24/2016 8:00AM blood draw:
CORTISOL, AM 12.0 ug/dl (4.3 - 22.4 ug/dl)
CORTICOTROPIN, QN, PLAS 50 (6 to 50 pg/mL)

6/30/2016 8:00AM blood draw (post Dexamethasone Suppression Test):
CORTISOL, AM <1.0 (4.3 - 22.4 ug/dl)
Dexamethasone,ser,qn 311 (180-550 ng/dL)

I need to ask the endo for clarity but it looks like the Dex Suppression test shows my pituitary is fine in relation to my cortisol. Maybe my adrenals are messed up? Or maybe the high cortisol is a result of hypothyroid? I’m leaning toward the later.

My endo was/is (haven’t heard back yet) on vacation for 2 weeks so I went to a new doc about 5 days ago, a Naturopath that deals a lot with hormones, and I like this doc so far. Doc actually sat down with me for an entire hour asking probing questions about my symptoms, walked through all my test results. He took notice to the thyroid issue so spent most of the time there but also pointed to my low pregnenolone.

He saw that I was Rx’d T4Levothyroxine 25mcg by the Endo and suggested I fill the script and take 2 per day along with 65mg WPThyroid, a natural desiccated thyroid (NDT) product from him. He also started me on DHEA 25mg 2x per day.

I started this protocol and felt better almost immediately. Been on it for 5 days now and it’s been keeping me at a fairly consistent 5/10 as far as performance, not dropping below a 2/10. It’s definitely better than where I was before this but it hasn’t been all sunshine and roses as I’ve experienced some weird sh*t in the past few days.

One afternoon I suddenly felt like I just took a massive dose of nyquil so I fell asleep for like 2 hours and another time I suddenly felt that nyquil sleepiness but then ate some food and then within 30 minutes my energy is back to full steam. Also experienced some mood swings, digestion swings, and some full blown salty/sweet food cravings for a few hours then they subsided.

I emailed the new doc and he said this stuff is normal, just my body acclimating to the treatment.

Overall, my energy is up, waking up feeling refreshed, libido returning, motivation to get sh*t done is back, muscles feeling tighter, body temp is now fluctuating between 97.4 upon waking up to 98.6 mid-afternoon (formerly maxed out at 97.4 mid-afternoon), salty/sweet food cravings are subsiding, no longer sweating in sleep, and I actually hit the gym yesterday for the first time in a month and felt good.

For the short-term the plan is to stick with this protocol for 1-2 weeks, and then check in with the doc to see where I’m at with symptoms, and evaluate whether or not to make changes.

Based on the research I’ve done, here’s where I’m at. If you’re reading this your input is very much welcome so please feel free to chime in anytime:

Symptoms very much in alignment with thyroid problems so will continue to work on the thyroid fix.

High cortisol and low volatile body temps seems to be pointing to early phase adrenal fatigue but this could also be caused by hypothyroid for past few years. Don’t have rT3 number yet but will get it tested on the next round. High cortisol could also be a pregnenolone steal but haven’t looked deeper in to this and I don’t have a progesterone number so stuck here. I’ll be sure to get a progesterone test on next round.

High E2 could also be result of hypothyroid and fat around the midsection but DHEA supplement should help to lower it. Will revisit this on next round of blood tests.

Low Pregnenolone I’m still clueless about, however at least the DHEA supplement should help the sex hormone side of the cascade.

Low ferritin and lower than optimal iron levels could be due to hypothyroid and stomach acid/absorption issues so I’m taking iron supp and no longer drinking alkaline water, just regular water.

Sub-optimal FT and TT is likely due to the hypothyroid so I’m going to leave it alone for now as I adjust thyroid treatment and see if my levels are up during my next round of labs.

Naturo Doc recommended I follow this “Eat your blood type” protocol http://www.dadamo.com/. I’ve checked it out and it’s in pretty good alignment with my normal nutrition so I’ll give it a shot but does anyone have experience with this?

Although I’m not 100% yet, not even close, it feels good to be back in the game and much of which I can attribute to the the advise, stories, and direction I’ve seen from everyone on these boards, so thank you, I appreciate you!

If you’re reading this you’re input/experiences are very welcome.

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I agree with KSman, I think its totally thyroid related and if its driving down your LH it can lower your T levels. If you get this tuned in I wouldn’t be surprised to see normal levels as yours are borderline. Equalo is also right about the scale, but I think referencing other labs scales is incorrect. The lab determines the scales due to their testing methods so each lab is different and according to their scales your Free T is pretty optimal.

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Pregnenolone is made in the mitochondria inside the cells in your body. Mitochondria also make ATP, the universal currency of cellular energy. Mitochondrial metabolic rate is controlled by fT3 as part of your body temperature control loop.

Things coming into focus now? Thyroid controls mitochondria, controlling pregnenolone production, energy and temperature.

In the adrenals, pregnenolone → DHEA if there is enough pregnenolone. And adrenal problems can affect DHEA production.

Also, males produce a lot of pregnenolone inside the testes. I see a fT3 connection there too. When I started TRT, before hCG, my testes shutdown and my pregnenolone and DHEA both went down.

Women store more iodine than men. They store iodine in breast tissue to supply iodine to nursing babies. I am a bit reluctant to go along with high dose iodine during nursing. You can research that. That been said, iodine is very important for babies and children. Also very important is essential fatty acids. Mom could try fish oil, nuts, flax seed oil/meal. A lot of the dry mass of the brain needs to be EFAs. Higher EFA intake during pregnacy, nursing and formative years does have an impact on development and IQ.

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Brass,
Your iron/Ferratin is low from the blood donating. I’m sure your copper is as well. These things can cause strong fatigue…

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Thanks Ztanzanite, I appreciate the feedback.

Been working on this for the past 2 years and nearly forgot about it till you responded to it so thanks for the reminder.

For those reading this now and in a similar situation please do yourself a favor and do not stop LEARNING and TESTING to find an answer because in the end when your performance comes back you’ll find that it was all 1000% worth it.

It took reading and watching videos A LOT, like hundreds of hours, tons of studies, tons of books, and finally finding a doctor that knows what he’s talking about, it appears that an unhealthy and imbalanced digestive system is the source of my problems.

Most likely what happened was that the years of abuse of my digestive system (i.e. removal of amalgam fillings [this is a huge mercury dump in to your body but you have to remove these as they are poisoning you], casual rounds of antibiotics, environmental poisoning from things like bug poison and mold, lots of alcohol and sugar in earlier years, etc…) left the door open for some pretty nasty imbalances to form in my gut, which grew exponentially, which led to more imbalances through out the rest of my body including endocrine system, neurotransmitters, mitochondrial function, among others.

It’s impossible to know what exactly triggered my crash, however now looking back at where I am now versus that of my past, I’m confident it was a combination of things (some mentioned above) that led to the gradual (like over 15-20 years) deterioration of my health. The crazy part his that it happened so slowly over such a long time I was unable to see the drastic changes happening until I hit rock bottom with the fatigue crash.

The main things I’ve learned:

  1. Question everything because your docs are NOT gods.

In fact, for illustrative purposes, I’ll echo what KSMan said a thousand times… most doctors are idiots. Don’t get me wrong, some are geniuses. Find the geniuses and listen to them, however it takes your knowledge of your condition in order to identify and weed out the idiots. Read one “alternative” medical book and you’ll likely know more about your medical issues than your doc.

For example, I read a few books about the endocrine system, how thyroid hormones work, and how they’re effected by various conditions in the body. Went in to see an Endocrinologist and this doc couldn’t speak intelligently with me regarding thyroid questions, couldn’t interpret all of my tests, and then was upset at me because of this.

Keep in mind that in our medical system doctors don’t get paid more to keep up with current medical science and give you the right advise, they are paid based on the amount of patients they can see in a day, which is why your last visit with your regular doc was likely 10 minutes max.

  1. Test. Test. And test again. A million different factors can cause a false-negative or false-positive tests and some tests are simply unreliable so be sure to get tested at least 2x for any one issue and make sure you’re knowledgeable enough to get your doc to order the RIGHT tests.

For example, in the past 2 years I’ve completed 3x CDSA (stool analysis) and all 3 came back squeaky clean, and negative for candida. Upon looking at my blood under a microscope at the recommendation of a genius doc, I was able to see candida among my blood cells.

If candida is getting in to my blood stream then the candida in my digestive system is likely high. Also a clue that I was having inflammation in my gut (leaky gut) allowing the candida to enter the blood stream.

I did a candida protocol via a super clean keto diet (no dairy, no pork, no processed foods, no cheat days), supplements, and Rx meds and I’m down 20lbs in the past 2 months, my mental performance has increased substantially, and my blood is noticeably cleaner (little to no candida) than the last microscope session.

  1. Learn to interpret your tests. Most doctors use single blood work/test markers to diagnose health conditions (likely because they have to code your diagnosis for insurance purposes) and they do not have the knowledge necessary to look at the big picture of your blood work and other tests. If your condition or treatment is outside of the traditional medical insurance spectrum, the docs typically have no knowledge about it.

For example, one of my first rounds of bloodwork showed that my iron and ferritin were low, however my first doc (an idiot doc) disregarded that because my numbers (borderline) fell “inside the normal range”. He didn’t have the knowledge to “connect the dots” with my other test results.

When I finally found a genius doc he could see, by looking at my blood under a microscope, that I did in fact have a major iron deficiency. I did an Iron replacement protocol and after 2 months my iron levels came up to normal but then dropped again shortly after I stopped the protocol.

Based on that and a few other symptoms we came to the conclusion that there is something leeching the iron from my body, likely my digestive track, which is likely an intestinal parasite. I’ve tested for parasites 3x in the past 2 years and all tests came back negative.

  1. Don’t be afraid to spend money on tests and doctors. I’ve spend tens of thousands of dollars hacking my health issues. I’ve gone as far as overnight shipping my blood samples to different countries to get a test that wasn’t available in the USA, and it’s the best money I’ve ever spent. It was a lot, but it was worth every penny.

They say that “health is wealth” however you can never really tell what your improved health is worth until you resolve the issues you have and likely if you’re reading this post your health is in some way deteriorated. This journey for me has been far from easy, however I can promise that it has been worth it to get from where I was in 2016 when I crashed to where I am now.

Outside of that it’s been a hell of a roller coaster ride. I’m not even fully recovered yet, still have things I’m working on, however I’m on track and my symptoms are definitely improving.

Best wishes!

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