T Nation

Been to Three Different Doctors

Hi everyone,

As the subject title says, I have been to three different doctors over the last year or so. These doctors were all at ‘wellness’ type centres and were also suggested by some compounding pharmacies that I rang. Each of them did blood tests had suggestions as to what was ‘wrong’ with me.

I am not totally sold on what any of them have suggested so far.

Firstly, the information requested in the “Advice for New Guys” sticky:

Age - 36 years

Height - 6’4"

Waist - 33"

Weight - 190lbs

Describe body and facial hair - My facial hair has only just ‘filled in’. I didn’t start shaving until I was about 20. Similarly, chest hair only started in my 20’s and there still isn’t that much there. Arms and legs have always had hair.

Describe where you carry fat and how changed - I have newer had trouble getting lean if I wanted. I think I carry proportionally more fat in my lower back/love handles and maybe in my legs.

Health conditions, symptoms [history]

These symptoms seems to have started maybe as long as 10 years ago but have gradually got worse to the point where they are now intolerable.

  • Fatigue - I generally feel tired throughout the day and if I could I would just sit on the couch all day. When I wake up in the mornings I really struggle to get going, even though I average 8 hours of sleep a night. Often I will have to sit on the bed and ‘psych’ myself into getting up. I struggle with workouts but persist because if I didn’t work out when I felt down, I would never workout. I struggle to get through workouts and often even during the warm-ups am feeling tired. Years ago I used to be able to workout intensely for 1.5 hours but I have had to scale right back in the last few years.

  • Cloudy mind - This is something I have mainly noticed in the last year or so but then again, I think my memory has been getting worse for a while. I find it really hard to concentrate, even when driving. I am really struggling at work. It feels like my mind is filled with bricks or something. I think most of the time I get by on auto pilot rather than really absorbing what people are saying etc.

  • Anxiety - Maybe I have always had this and it is worse now as I have more stressful situations to deal with (eg. kids). It is at the point now where if something goes wrong, ie kids playing up or I am running late, I get so worked up that I can physically feel it. When this occurs I also get very angry/irritable.

  • Loss of libido - I have no real desire to have sex. If it does get started, ie wife initiates it, then I am into it and everything is fine but I just don’t seem to desire it.

  • Sensitivity to noise (and possibly light) - I’m not sure if this is related to the anxiety.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Real dangers! see this http://propeciahelp.com/overvi

I used Proscar on two separate occasions, each for maybe a period of a year. I would guess this was around 2002-2003 and 2008-2009.

I also used Accutane for acne for around six months in about 2004.

Lab results with ranges

I wasn’t able to get all tests from the different doctors I saw. Where available the results below are the most recent ones I have (taken 31/03/14). Otherwise, I have posted older results where the current doctor didn’t test for something.

Total T - 16 nmol/L (10.0-33.0)
LH - 4 U/L (3-20)
FSH - 7 U/L (3-20)
E2 - 60pmol/L (<150)
DHEAS - 2100 ug/L (800-5700)
SHBG - 39 nmol/L (10-70) (taken 1 month ago)
Free T - 263 pmol/L (260-740) (taken 1 month ago)

TSH - 1.4 mU/L (0.4-4.0)
free T4 - 12 pmol/L (10-20) (done 6 months ago)
free T3 - 4.0 pmol/L (2.8-6.8) (done six months ago)
rT3 - 382 pmol/L (140-540) (was 503 6 months ago)

Saliva Cortisol (all done 6 months ago)
morning - 19.7 nmol/L (6-42)
midday - 10.4 (2-11)
afternoon - 7.6 (2-11)
evening - 3.0 (1-8)
Saliva morning DHEAS - 29.9 nmol/L (5-30)
DHEAS/AM Cortisol - 1.52 (0.2-0.6)

Serum Cortisol
8am fasting - 400 nmol/L (220-720)
4pm - 70 nmol/L (110-360)

Iron Studies
Iron 19 umol/L (10-33)
TIBC 46 umol/L (45-70)
Saturation 42 % (16-50)
Ferritin 517 ug/L (20-320) (this has been high for the last year)
Haemochromatosis - negative

FBC
All within range, although Neuts was previously low (can post values if necessary)

Urine Iodine - 35ug/L (WHO classification - moderate deficiency)

Sodium 140 nmol/L (135-145)
Potassium 4.1 nmol/L (3.5-5.5)
Chloride 106 nmol/L (95-110)
Bicarb 26 nmol/L (20-32)
Anion Gap 8 nmol/L (5-15)
Ca (corr) 2.32 nmol/L (2.10-2.55)
Phosphate 1.2 nmol/L
Urea 7.6 nmol/L (3.0-8.0)
Uric acid 0.33 nmol/L (0.2-0.5)
Creatinine 98 umol/L (60-110)
eGFR 85 (>59)
Fasting Glucose 5.1 mmol/L (3.6-6.0)
Total Protein 80g/L (66-83)
Albumin 49 g/L (39-50)
Globulin 31 g/L (20-39)
Bilirubin 19 umol/L (4-20)
Alk Phos 77 U/L (35-110)
AST 24 U/L (10-40)
ALT 30 U/L (5-40)
Gamma GT 10 U/L (5-50)
LDH 159 U/L (120-250)
Cholesterol 3.4 mmol/L (3.9-5.5) (has always been slightly below range)
Triglycerides 0.4mmol/L (<1.5)
HDL 1.12 mmol/L (>1.0)
LDL 1.39 mmol/L (<2.0)

Vit D3 70 nmol/L (50-300) (this is from a year ago but couldn’t find more recent ones which were higher)

Mercury 20 nmol/L (0-60)

Describe diet [some create substantial damage with starvation diets]

Have lost weight over the last year after ‘bulking up’ for a year or so. Not a restrictive die though. I have always been able to lose weight with little effort. All I have to do is not force feed myself and I lose weight these days. Carbs and protein in the am and protein and fats in the evening. A variety of fats including red meat, nuts, avos, coconut oil, olive oil, fish oil.

Describe training [some ruin there hormones by over training]

Typical bodybuilding split until recently where I have been doing an upper/lower split 4 days/week.

Testes ache, ever, with a fever?
Never

How have morning wood and nocturnal erections changed
Don’t get them anymore, except when I really need to go to the toilet (I think it is the body’s natural defence while sleeping).

In terms of what the three doctors thought:

  1. The first doctor was concerned about the high Ferritin. He tested for haemochromoatosis which was negative. He then referred me to a haematologist who didn’t really find anything except Cytomegalovirus (CMV). The doctor was excited that he had found my problem. I decided to go somewhere else.

  2. The second doctor did the SHBG and free T and found the free T was low. He said I should take zinc. He was also concerned with my mercury result and wanted to try and lower that with a product called ‘Chelex’. Since I had already been taking 50mg of Zinc a day I wasn’t very impressed with this outcome.

  3. I just saw this doctor recently. This is the doctor that the majority of the above results come from. Finally a doctor who tested E2, LH, FHS and rT3. Although he doesn’t believe in free T (which is annoying considering my previous low result). He also tested DHEAS.

Doctor 3 was concerned about iodine and the low afternoon cortisol. He also said my T and DHEAS could be higher. He has prescribed Lugol’s Iodine (6.25mg increasing to 12.5 increasing to 18.75), DHEA (15mg/day), Andrenotone (3 tablets/day) due to the low afternoon cortisol and a Magnesium supplement.

I find it strange that Iodine came back low from the urine test as after measuring body temperatures last year (usually around 96.5 in the morning) I used Iodoral at 12.5mg increasing to 18.75mg/day for about two months. Morning temperatures never really got above 96.9 (evening temps were around 97.8 at the most but were often just over 97). Does the urine iodine test have any merit?

I have just started taking the stuff that doctor 3 prescribed. I am still concerned about the low free T though which this doctor did not test.

Any help or suggestions would be greatly appreciated.

Sorry I have nothing to assist you at this point but I was curious about the lugols you were prescribed. Did you get this at the pharmacy or was it OTC? What is the strength of it? I have had trouble obtaining a stronger lugols and wondering if such products exist.

[quote]MdavisUSF wrote:
Sorry I have nothing to assist you at this point but I was curious about the lugols you were prescribed. Did you get this at the pharmacy or was it OTC? What is the strength of it? I have had trouble obtaining a stronger lugols and wondering if such products exist.[/quote]

It is 10% Potassium Iodide and 5% Iodine.

I’m in Australia if that makes a difference. I thought I read somewhere that liquid iodine of the strength I listed is not available in some countries. I got mine from a chemist. My doctor wrote me a prescription for it but I didn’t need the prescription in the end.

Based on the lab results, my main concerns are the low free T (obviously) and the low LH.

Considering the low LH, I thought it might be worth trying a SERM restart? There is a few threads I have found that talk about rough protocols, although nothing definate so I’m open to suggestions.

Having struggled with my doctors refusing to treat my low T symptoms because my levels were in the “normal range”. I can commiserate. Blood levels are based on an average from all age ranges, and a lab value that would fall in the low normal range would be fine for an 80 yo codger, would be disastrously low for a 36 yo.

I suffered for over three years and I believe I was able only to achieve low enough levels (to allow treatment begin ) by having my morning blood draw performed as late as possible. (Most US labs consider blood drawn before 10 am-Morning draws) You may wish to begin there.

Low LH is usually accompanied by a low FSH. Difficult to really assess at this point. The low cortisol also may be a factor to look at. If you have had a history of headaches and or vision trouble, see if you can get your doctor to order an MRI of your pituitary.

Second, you could try and find an endocrinologist. That may also be a good resource for you. (although I had to educate mine along the way.)

Good luck and Cheers.

LH (Luteinizing hormone) is secreted as pulses, it is necessary to follow its concentration over a sufficient period of time to get a proper information about its blood level. So depending on where you were during the blood draw it could be normal, high, or low. It’s really not that helpful.

Your Free T is low and that’s what gets the job done.

Your Cholesterol is low. You should be eating more meat, eggs, increase your intake of saturated fat. DHEA might come up some too. Demographic studies suggest that cholesterol levels form an U-shape curve when plotted against mortality; Low cholesterol is usually a marker of poor health. Some people with Low cholesterol suffer from anxiety and depression.

Your thyroid looks ok but…

How to calculate your reverse T3/T3 ratio?

To work out your reverse T3/T3 ratio divide the total free T3 by the total reverse T3 and multiply this by 100. The ratio should be between 1.06 to 2.2 and ideally towards the upper end of this range. If this reverse T3/T3 ratio is at the lower end or below this range it strongly indicates reverse T3 dominance is occurring. Yours is 1.047. Can be caused by low calorie intake, Stress, etc. http://www.stopthethyroidmadness.com/reverse-t3/

You Ferritin is high but your Iron, TIBC, Saturation and AST and ALT are in range and you don’t have Haemochromatosis. Have you ever been tested for Viral hepatitis, Fatty liver or Inflammatory conditions? (C-reactive Protein (CRP)), drink a lot of alcohol? smoke?

Vitmain D3 is low. You should get more sun or take 5000IU Vitamin D3, Cholecalciferol a day.

Does the urine iodine test have any merit?
As over 90% of the body’s iodine is exerted in the urine, urinary excretion of iodine is currently the most commonly used marker of iodine intake. It may be used as an indicator of deficiency; however, if the aim is to obtain an accurate estimation of habitual intake in an individual, several 24h urinary collections may be required. (Comprehensive Handbook of Iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects)

[quote]DocRad wrote:
Low LH is usually accompanied by a low FSH. Difficult to really assess at this point. The low cortisol also may be a factor to look at. If you have had a history of headaches and or vision trouble, see if you can get your doctor to order an MRI of your pituitary. [/quote]

Thanks for the reply DocRad!

I wasn’t sure what to make of the lowish FSH=7 (3-20), whether this is fairly normal or when looked at in conjunction with the low LH could be a problem.

The afternoon cortisol was very low and that is something the third doctor is trying to fix with a product called ‘Adrenotone’ (Siberian and Korean Ginseng, Winter cherry, Golden root, Liquorice and Tyrosine). I’m not sure how it relates but about six months ago I did a 4 x saliva cortisol and they were all within range. (Except for DHEAS and the DHEAS/Morning Cortisol ratio which was throught the roof. The report said i wasn’t reacting to stress properly and the body was producing DHEAS instead of cortisol).

I don’t get headaches but I do seem to have something ‘wrong’ with my vision. It’s hard to explain but I can’t really focus properly and it seems a bit blurry or something. I also seem to be very sensitive to light.

[quote]Second, you could try and find an endocrinologist. That may also be a good resource for you. (although I had to educate mine along the way.)

Good luck and Cheers. [/quote]

Yeah, if I don’t get anywhere with my current doctor I might give that a try.

[quote]jb13 wrote:
LH (Luteinizing hormone) is secreted as pulses, it is necessary to follow its concentration over a sufficient period of time to get a proper information about its blood level. So depending on where you were during the blood draw it could be normal, high, or low. It’s really not that helpful. [/quote]

Thanks for the reply jb13!

Yeah, I read this just recently. On my latest blood results it does actually list two previous LH readings. The first was LH=5 (3-20) in 2009 and the second was LH=4 (3-20) last year.

Yep. This was from a test by the second doctor done about two months ago. He prescribed me zinc (had been taking it beforehand anyway). That prompted me to find a new doctor. The new doctor said he doesn’t test for free T, which from what I have read is kind of stupid.

So my low normal total T combined with a moderate to high SHBG is resulting in low free T.

I think my cholesterol has been slightly below the range for as long as I can remember (10 years or so).

This is where I get a bit confused. I have seen many recommendations for people with lowish cholesterol to increase fats etc. I have also seen it mentioned many times that dietary intake of fats/cholesterol only accounts for a very small part of cholesterol levels.

I would say that over the last 10 years or so, on average, I have probably eaten red meat once a day, eggs once a day, nuts twice a day and taken about 15 fish oil caps per day.

[quote]Your thyroid looks ok but…

How to calculate your reverse T3/T3 ratio?

To work out your reverse T3/T3 ratio divide the total free T3 by the total reverse T3 and multiply this by 100. The ratio should be between 1.06 to 2.2 and ideally towards the upper end of this range. If this reverse T3/T3 ratio is at the lower end or below this range it strongly indicates reverse T3 dominance is occurring. Yours is 1.047. Can be caused by low calorie intake, Stress, etc. http://www.stopthethyroidmadness.com/reverse-t3/
[/quote]

Yeah, I have read that this should be around 20. The comparison could be a little out as the free T3 was done six months ago and the rT3 was just done. The rT# I had done six months ago was even higher and at the time resulted in a ratio of about 0.8.

I definately stress a lot. Not necessarily due to stressful situations but more like I make the situation stressful. This is the anxiety I mentioned.

I have had the iron studies test done about 8 times in the last 1.5 years and all of the results are similar to this (Ferritin was above range in all of them and the others tended to be either low normal or below range. For one of the tests where Ferritin was high and the others were low, the report said “Iron studies consistent with either chronic disease or possibly an acute infective or inflammatory process.”

Due to these results and the fact that I was negative for heamochromatosis, the doctor referred me to a heamotologist. He did more blood tests and his conclusion was that the iron study results were caused by inflammation due to cytomegalovirus. This was six months ago though and the Ferritin is still high.

The heamotologist checked for fatty liver with an ultrasound and it came back ok.

I smoked heavily for about two years about 15 years ago. I also used to binge drink when I was younger (10 years ago).

Not sure about the viral hepatitis but as mentioned above, I apparently had CMV and at some stage I have had mononucleosis.

CRP sounds familiar (thought I might have had a test for it) but can’t seem to find a result.

This test was old but it was the only one I had. I since started supplementing with Vit D and the level came up.

I have been taking the iodine for three weeks now and temperatures haven’t changed at all. Dose was 6.25mg/day for the first week, 12.5mg/day for the second week and 18.75mg/day for the third week. Over the last few days, my temperatures have been as follows:

Morning (6am) - Ranging between 96.4 and 97.0

Evening (6pm) - Ranging between 96.8 and 97.2

Interesting that my temperatures are low in the evening as well. It’s not the thermometer either as I have had others use is and record higher temps.

Could this be due to my high rT3?

In another thread I saw someone post a link to the thyroid-rT3 website. It is very interesting and talks about a process to lower rT3. The process involves using T3 only medication to stop the bodies production of T4 and therefore the conversion to rT3. Does anyone have any experience with this?

I can’t say I am feeling any improvements from the DHEA either. Although it has only been three weeks and from what I have seen elsewhere 15mg/day is a very small dose.

Based on my labs, can anyone provide an opinion on whether a SERM restart might be worth a try?