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Adrenal Fatigue. Low cortisol, Elevated TSH and rT3. Possible Inflammation Issues

Hi everyone,
Looking for some input and feedback on my labs. I’m 24, primary issue is low libido. I also feel like dog shit most of the time with fatigue and brain fog.

Total Testosterone 26.8 nmol/L (9.5-35.0)
SHBG 54 nmol/L (10-70)
Free Testosterone 439.8 pmol/L (260-750)
Estrogen 95 pmol/L (<100)
LH 3 U/L (1-8)
FSH 10 U/L (1-8)
TSH 2.71 mU/L (0.4-4.0)

Total T is almost 800ng/dL which is quite healthy.

My Dr has referred me to an endocrinologist and for a fertility test due to elevated FSH.

From my research, SHBG is quite high and free T is on the low end. Do I need TRT? Do you think I could improve my hormones and testosterone naturally?

Thanks all, really appreciate any input

Your SHBG is not all that high, slightly above mid-range. Same goes for your Free T, which is dependent on both total T (which is good) and SHBG (which is mid-range). At the age of 24, I’d look elsewhere for a source of your low libido issue. TRT is a life-long medication and will create difficulty in remaining fertile, if such is your desire.

Your E2 is at the high end of normal, but that’s not a concern as your T is at the high(ish) end too. E2 is made from T, so when T is elevated, E2 will follow. E2 is a difficult hormone to measure and in my experience seems to jump around for reasons unknown. I personally don’t get excited about E2 unles it is way out of range (about double the high end of normal).

The FSH is a bit of a quandary. Yes it is a bit elevated, but that could be simply hitting on a spike of this episodic hormone. What is a odd is that it is elevated while LH is not. They share the same releasing hormone (GnRH), although there is separate feedback inhibition of FSH. I’d be interested in what your endocrinologist has to say about that and the results of your fertility testing.

Expanding on your past history would help. However, given what you have posted, I’d check prolactin, VitD, DHEA-S, IGF-1, fT3 and fT4.

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Your TSH is on the higher end so would be good to see your Free T3, Free T4 and Reverse T3 to see how your thyroid is doing.

It would good to see how your adrenal glands are doing by checking saliva cortisol over the day and dhea-s blood levels.

It would be good to see if you have some kind of inflammation, with hs-crp, ferritin + iron, cbc and etc.

I really doubt that your symptoms are due to your T levels.

Thanks everyone,

I will see if I can get more blood testing done, especially for the thyriod.

Funny that you mention adrenals, I suspected adrenal fatigue could be an issue early this year.

Good to hear that T levels are OK for now.


Let me know when you have the new blood work

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Thanks for the feedback it is much appreciated @youthful55guy.

When you say E2 is elevated, 95pmol/L is about 26 pg/mL. Don’t most people on here advocate for E2 = 22 ? Not that far off.

I’ll look after my liver and hopefully SHBG will come down with time. Years of partying, alcohol & drug use probably hasn’t helped it


You always need to look at hormones relative to the normal range for the laboratory doing the testing. These ranges can be very different between labs and the methodologies they use. Your lab has a normal range of <100 pmol/L and yours is 95, so just slightly less than the upper end of the normal range.

I would make sure that you are using the correct lab for measuring male E2. It is quite confusing and controversial (like a lot of things) in this forum. Many docs simply do not understand the difference between them and order the standard (direct) method immunoassay designed for women. It simply is not sensitive enough to measure lower levels of male E2, so you will always test high using that test method. There is a direct method designed for men (aka the sensitive or ultrasensitive method) that is much better, but even it has its problems with potential cross-reactivity. The Endocrine Society recommends (and so do I) the LC/MS test method. It’s a bit more expensive but avoids the potential for false high results.

Good nutrition and minimization of alcohol is a good start for lowering SHBG, but there is a portion of the population that is just genetically programmed for higher SHBG and this will just get worse with age. I am one of those people. My SHBG typically runs in the mid 70s to mid 90s. There are some synthetic anabolic hormones that will bring it down, but I’ve chosen not to go down that road. It’s impossible to get docs to prescribe them off label and I prefer to stick with scripted drugs when possible. I simply adjust my T dose so that the SHBG protein becomes saturated and enough spills over to Free T to keep me in the optimal Free T range.

Also with regards to my thyroid, my fT3/rT3 ratio is 11.4, a healthy ratio should be higher than 20. (reference - stopthethyroidmadness).

High rT3, Low AM cortisol, caffeine intolerance - could this all be pointing towards adrenal fatigue? I’ll get a 4 point saliva cortisol test done to confirm…

Alrighty guys, finally got some more labs done. Please see below.

Test 1. Completed at 8.10AM. Fasted
Vitamin D 117 nmol/L (50-150)
Vitamin B12 326 pmol/L (139-651)
Active B12 119 pmol/L (23-100)
Iron 13 umol/L (5-30)
Ferritin 172 ug/L (30-500)
Folic Acid 12.7 ug/L (>3.8)
TSH 2.71 mU/L (0.4-4.0)
FSH 10 U/L (1-8) High Abnormal
LH 3 U/L (1-8)
Oestradiol 95 pmol/L (<100)
Testosterone 26.8 nmol/L (9.5-35.0)
SHBG 54 nmol/L (10-70)
Free Testosterone 439.8 pmol/L (260-750)
Dihydrotestosterone 2.10 nmol/L (0.4-2.5)

Test 2. Completed at 9.30AM. Fed state.
Oestradiol Lab 1 <85 pmol/L (<100)
Oestradiol Lab 2 (I think Sensitive) 70 pmol/L (<100)
Morning Cortisol 161 nmol/L (150-535)
TSH 2.98 mU/L (0.4-4.0)
Free T4 12 pmol/L (9-19)
Free T3 4.0 pmol/L (3.0-5.5)
Reverse T3 352 pmol/L (140-540)

Fertility Test came back really good:
Volume 4.0 mL (>1.5)
Sperm Concentration 62x10^6/mL (>14)

My primary issues are very low libido and also issues with fatigue. I don’t feel like a healthy 24 year old.

Testosterone and thyroid look sub optimal in my opinion, with free T and free T3 being on the low end of the reference range. Could I also have adrenal fatigue with that low AM cortisol? I find I cannot tolerate any caffeine, it makes me feel terrible, could be a link? I did go through an extreme amount of stress last year, so its very possible.

Do you guys think I’ll benefit from some of the biohacks, like iodine + selenium for thyroid, and boron for free testosterone?

Thanks everyone it is much appreciated. I have spent the last couple weeks reading up on many posts on this forum, lots of smart people here & good discussions, I have learnt a lot.

@youthful55guy @kratom_dumper

I wish I had some words of wisdom to give you, but your HPTA and thyroid labs look really good with the possible exception of the fT3/rT3 ratio. The latter could be a temporary problem. Poor nutrition, excessive exercise without adequate recovery time, and infections can all push the ratio down. Given what i see, and your age, I would not recommend TRT. Possible consider enclomiphine (not clomiphine), but again, your labs look pretty good so I doubt a doc would prescribe it.

Regarding biohacks, I don’t have a lot of experience with them other than the supplements that are supposed to bring down SHBG. They never worked for me, but I am part of the population genetically programmed for high SHBG, so I’m probably not a good test subject regarding effectiveness for the other 90+% of the population with normal SHBG.

I would consider getting your vitamin D levels up. While not bad, they could be improved. I like to be in the upper 75th percentile, but do not exceed the upper end of the range. You might want to try adding 2000 IU per day (or increasing it by that amount if you already take it).

I’m not concerned about your E2 levels, so I would not muck with any type of E2 control. It might just mess you up further.

Bottom line, I would focus on good nutrition and a sound exercise program.

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Your TSH is a bit elevated, the median TSH value is closer to 1.0 (under 1.5). Low cortisol would affect your body’s ability to get thyroid hormones into your cells, because without cortisol your body cannot use thyroid hormones and I believe this is why your TSH is slightly elevated.

I think adrenal fatigue is the cause of your problems, TRT isn’t the answer as it will take you low cortisol to a whole other level. Your night time cortisol must be very low.

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Thanks for the info & assistance to help me diagnose my issues. Reading up on adrenal fatigue, many things really relate to what I’m going through. I will get an adrenal function / 4 point cortisol test done asap. Much appreciated

Really good info here. I appreciate your time & feedback. I’m already taking 5000IU vitD per day. Will do some more research before bumping it up. Also going to get further testing done for adrenal fatigue, a lot of what’s stated online really resonates with me. Thanks

With that low iron and with that high ferritin you 100% have some kind of inflammation going on. You want iron around 25-28 with a ferritin of 100-110.

Also your RT3 is too high which can also happen due to inflammation.

Blood cortisol is often pretty useless but your levels are shit, you want 500-535. And low morning cortisol points to long term stress/inflammation.

Do you know why you have some inflammation going on? I went years with pretty much the same values as you (which eventually made me sick enough to not be able to work) and it turned out that I had several different tick born infections. So make sure to really find out why you have inflammation in your body and I can promise you that you will be feeling much better once you get that fixed.

You should start with an antibody test on your thyroid since your thyroid is pretty shitty.

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Hey man, thank you so much for the insight.

I’ve had the following labs done previously as well (this was in November 2019):

S TgAb <10 IU/mL (<115)
S TSH_Roche 3.92 mU/L (0.5-5.5)
S TgAb <10 IU/mL (<115)
S TPOAb <10 IU/mL (<35)
S ACE 20 U/L (20-70)
S RF <10 IU/mL (<20)
S CRP <1 mg/L (<5)
IRON 16 umol/L (5-30)
FERRITIN 234 ng/mL (30-500)

I actually was taking iron supplements at this point in time, so that may have impacted the iron/ferritin.

Looks like these are my thyroid antibodies and some other autoimmune diseases, which all came back fine.

Interesting you mentioned inflammation - does the CRP lab test coming back normal indicate this shouldn’t be an issue?

Reckon I need to eat more meat to up my iron?

I saw a naturopath recently who looked into my eyes and reckons I have adrenal fatigue from the iridology. Not sure if this is legit, sounds like BS to me though. Adrenal fatigue makes sense to me though as I had a severe stress event last year followed by chronic “fight or flight” till burnout.

@kratom_dumper what do you think? Interested to hear more about possible inflammation issues.


Hey man, ever get this figured out?

Yeah man, honestly doing so much better now days. I started following the advice of the fella below. Turns out I was running on that wired, adrenaline, stressed state constantly. Check out his video, he explains everything there. My testosterone has improved substantially and I’m now at the very high end of the reference range, cortisol has come up, and for the Thyroid I have added in a Natural Desiccated Thyroid supplement. I used to wake up in the morning feeling completely drained, then at night I would get that “second wind” with a huge adrenaline / cortisol rush, classic adrenal issues. Fixing my sleep and circadian rhythm has fixed this issue, and I now wake up in the morning feeling energized and ready to go! The #1 thing that helped my recovery was getting out of that wired state and focusing more on relaxation. Hope it helps!

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Awesome to hear. And I appreciate the response.

Did your iron levels ever improve? It looks like you were low but also indicated inflammation which mine are pretty similar.

I’ll definitely implement the things that guy says as it’s sure to help. But would you say that thyroid medicine made a difference?

Yeah, I had my highly sensitive CRP checked around the same time last year and it came back slightly elevated at 2. After months of just living an extremely healthy lifestyle, focusing on good sleep every night, eliminating stress, doing everything that Health Recovery talks about, it’s now dropped to <0.1 !!

I think the inflammation was because my body was stuck in a stressed catabolic state for so long.

I have been taking iron supplements on and off as advised by my integrative medicine doctor. He said my Iron was low as well, but he wasn’t really concerned.

Hard to say if the Thyroid helped to be honest, my TSH was at 3-4, which is pretty sub optimal and rT3 was elevated, likely due to severe chronic stress for so long. I’m still yet to get my Thyroid checked again, so can update you once I get my next labs done, but if TSH is still elevated and rT3 is still elevated, I might try and add in some T3 and see how I feel.

I was running on adrenaline for so long, pushing myself through everything, constantly wired, which lead to burnout. Biggest things for me was eliminating stress and getting good sleep every night!!