T Nation

Complicated Case...Please Help!


Hey guys,

       I'm 29 years old and have had fatigue and brain fog for a while.  My last free T was 11.5(reference: 9.5--26.5) and my total T was 563(reference: 280-800).  E2=60(reference=7.6--42.6).  I was taking ORAL compounded DHEA 100mg at the time as well as 100mg of sublingual Pregnenolone drops.  Now using sublingual compounded DHEA drops approx. 50 mg/day.  Stayed on same dose of pregnenolone.  Also take One grain of Armour BID.  Other results of note:

Free T4=1.17(0.82-1.77)

TSH=0.428 Low(secondary to Armour)(0.450--4.500)

Free T3=4.3(2.0--4.4)
Cortisol=12.4(2.3-19.4)Taken at Noon.

Cortisol is affected though b/c I take Adderall which will artificially raise it. So I'm wondering if it would be REALLY low without the medication. I know 24 hour salivary is better(I'm in the medical profession with a Doctorate degree), but I can't stop the medication just randomly like that. Still cold a lot with low energy. I'm wondering if high E2 is blocking T4-T3 conversion? Why is rT3 high? Someone said it should be 1/3rd of T3, but that doesn't make sense with the reference numbers I have from Labcorp.

Other important facts:
Vitamin D level is fine=60
Have high Candida levels(have eradicated in the past but comes back)
Low Alpha Melanocyte stimulating hormone which is likely behind ALL of this. Read the book Mold Warriors to learn a ton about hormones and how the immune system is involved with them intimately not just by draining the adrenals but b/c Alpha MSH is a MASTER HORMONE.
I felt much better while on high dose Resveratrol, calcium d glucarate, and myomins--sex drive went way up, strength went up, erections were better and semen volume was way up!
Will have Thyroid binding globulin and SHBG measured soon.
Body fat is around 18% despite lifting 3-4 days a week and taking fish oil, digestive enzymes and Betaine HCl.

It's good to get others' opinion as knowing as much as I do I go around in circles!

Thanks guys...


As many individuals as well as my self I chased my tail for years. Now I bring several years of experience both medically and personally to the forums. Myomin is not good because we do not know the mechanism by how it lowers e2 at what expense. It can cause abnormal function in specific liver cytochrome p450 which help detoxify other toxins, or drug. I would look at the root cause of why this happened by examing hidden stressors dealing from both emotional. environmental, biological, lifestyle, hormonal imbalances, nutritional and now genetics play a huge part in handling complex cases. Adderal can raise cortisol, that is why certain drugs can actual help specific part of the adrenals that may be under funtioning. One needs to get the proper blood work done in order to know where to start plus indept investigation by asking specific questions of the health professional. Many professionals spend a whole 15 minutes from time they walk in to the office and out the door your go. Endos are notorious for missing half or more of the boat. In my clincal expereince most endos end up making matters even worse. So look for the root cause by examing many factors with using clincal test to help verify were the problems lie.


What are DHEA-S levels? Your high dose DHEA, and pregnenolone may contribute, might be converting at a high rate to E2, then E2 represses your HPTA. You have to reduce your E2 levels. Some Rx and OTC drugs will push up E2 by loading up P450 enzyme pathways. You need to review these drugs as well as alcohol and other possibilities.

You may need to reduce the DHEA and pregnenolone.

Check waking body temp. If near or below 97F, then you have a functional case of hypogonadism from the effects of rT3. Others may explain how to deal with rT3 or provide links.

Have you been on a crash or starvation diet?

What are your cholesterol numbers?
Taking a statin drug?
History of deca only, promones, gear or hair loss drugs?


Experienced a lot of stress as a child with my biological father being an alcoholic and abusing my mother and verbally abusing my sister and me. Lots of sympathetic stress. When I was in middle school I went on a semi-starvation diet. Lots of stress in my last two years of private high school--lots of demands. Went to a top 25 college and crashed my senior year after a long period of overwork and also an eight hour surgery on my jaw. Lots of depression after college and difficulty with exercise etc.

KSman, my cholesterol is low, don't remember the exact number. BUT I am now supplementing with Sonic Cholesterol from New Beginnings, which HAN also uses I believe.

B/c I'm in the medical field, I work closely with an integrative medicine doctor. I've never been on all out HRT, but I take Test. drops once or twice a week. Approx. 150mg each time. However, sometimes I will go several months without them just b/c I get busy, etc. My labs have remained the same before and after me doing the T drops, so I'm guessing it didn't shut down the HPTA.

SPECIFICALLY, here are my questions: What can I do to lower rT3. And can anyone explain about the 1/3rd of Free T3 thing?

On my next test, I will have the following tested:
Thyroid binding globulin
T3 uptake
antithyroglobulin antibodies

I was chubby off and on as a kid so I carried extra body fat from too much junk food plus lots of stress=estrogen shower!

I'm still taking Calcium d-glucarate to escort estrogen out of the body and taking DIM/I3C convert the bad boys into good boys. When I took the High dose Resveratrol I felt much better which leads me to think that it's a receptor issue, at least in part.

HAN: what other tests should I have done since you talked about extensive testing in your post? Do a good job of rotating my foods for the most part. Have looked into all things environmental, which is why I mentioned the low alpha MSH. You guys really should read the book Mold Warriors. Mold is only a part of it. 25% of us that are chasing our tails with T really have the HLA gene, causing increased cytokine expression, brain fog, decreased drive, etc. Just a thought...

Anyone get tested for Lyme in here?


Look for Lyme discussion in another currently active post.
Learn to do this, better than the site's search:

Test LH/FSH, not LH alone.

Cholesterol is the foundation for a cascade of hormone production and creating your own vit-D3.

rT3 is T3 that is slightly different. It interferes with your T3 and that can make you have a functional T3 deficiency even when T3 lab values appear optimal. The treatment is dealing with known causes and not taking at T4 drugs, take T3 only. This stops T4-->rT3. There are rules of thumb for rT3:T3 ratios. Check waking body temps.

You have not responded to all of my questions.



          don't know my DHEA-S numbers.  Will add those to the test list.  I'm now on 50mg of sublingual DHEA per day, vs. 100mg of oral DHEA.


And no, I've never been on any hair loss drug or statin drug.


Stop the fish oil and the adderal. The adderal is frying your nervous system. That is why you have low stomach acid/enzyme production and therefore candida. Either that or you were working out too hard and exhausted your nervous system leading to less stomach acid production initially which gave you brain frog which made you take adderal which made you worse. SHBG would be good to know as well.


Please explain why elimination of fish oil would be of any benefit. What other EFAs would you consider a problem?


He's probably referring to the stuff from Ray Peat, that fish oils are bad...but I have no idea really.


The flip side, a diet with low EFAs is very unhealthy and dangerous.


I would advise to stop all the supplements because as mentioned they can mess with liver enzymes, which then in turn messes with hormone levels. I can understand taking a few supplements like fish oil, which have been proven safe, but I would stop taking the resveratrol, calcium d glucarate, and myomins and anything else.

Then just get the simple blood tests that are in the sticky. Hormones aren't all that complicated. If you have low T, take T, if you have low T3, take T3. Then, get more blood tests and adjust hormone levels to where you want to be.


thyroid-rt3.com has some pretty good information on that, as does stopthethyroidmadness.com


I would just have to start at the bottom base and work my way up disecting his case. There are several factors that need to be attended to. Alot of guys on the boards are trying to run before they can even roll over resulting in spending months or even years making them worse. There are just way to many variables to content with out more indept testing.

I would suggest to get proper testing done as indictated by ksman stickie as well as. Rt3 to me is just a sign of something else that needs to be further investigated and is not a cause. I see to many people trying to treat rt3 with high dosages of t3 in the end making adrenal weaker. Once the cause of the stress is dealt with the rt3 will return to normal.


Can someone explain to me how high RT3 would cause low T? I feel I may be in a similar boat from overdieting / IF'ing