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Desperate - Energy Close to Zero. Low Test, Low Cortisol - WWYD?


#1

Alright, so first of all – thank you all for the great forum. I’ve learned a LOT in the past few weeks reading here and it has been immensely helpful.

That being said, here’s my story / staus – things are a bit strange and I’m not quite sure I’ve found the right doctor yet, so I would be very thankful for any help.

Sorry for any typo’s and/or strange grammar – I’m from Switzerland and not a native English speaker, so I might mess up here and there :slight_smile:

Why I’m here, in a nutshell

I used to be “Mr. endless energy”. Very little sleep, lots of work done, even at home I was always “busy” building stuff around the house, loved it.

The past 2 years and past few months especially, I feel like someone “pulled the plug”. This came gradually and worsened over time.

My energy dropped what feels like 90%, I sometimes have to argue with myself just getting up and doing exercises, or even move around.

My motivation to work is completely gone which I fear will affect my business; instead of working for hours on ends (happily!) I now have to fight with myself to do the minimal amount of things.

I sleep 8, 9, 10 hours instead of 4-6 (which were more than enough for 20 years; I always slept very little since my earliest childhood) – and still feel like I didn’t get any sleep when I get up.

Also – but that’s not what bothers me most – despite regular exercise, I see now results. When I was younger, I would see immediate results, now I just can’t seem to make any gains (although that’s not a huge priority).

I’m not “burned out” in the sense that I hate what I do, quite the opposite; it’s just that the energy is gone to do the things I would love to do, in business and in private life. Even my wife said “I’m creeping around like a 90-year old”.

Medical Backstory

General information:

Male, 36 years old

183cm (6 feet)

81kg (178 lbs)– I’m down from 96kg (216 lbs), more about that in a sec.

3 healthy kids 2-7 years old

Overall, I consider myself pretty healthy. The occasional flu, but nothing serious for years.
Around 15 years ago, tonsils removed;

Around 10 years ago, appendix removed.

Ongoing issue - reflux

I had pretty bad reflux problems for many many years (family history – my dad had that all his life).

It’s not stress related, I just always had it; got worse over the past few years (also due to excessive eating/drinking while on business trips), magnesium carbonate based stuff wouldn’t work anymore, took tons of it just to be able to sleep.

In 2016 it got so bad that I went to see a doc and have a gastroscopy done.

Result: Barret Esophagus – my esophagus cells are pretty damaged and have mostly changed from esophagus cells into colon cells (typical for barret esophagus). Should check every 2 years to rule out that cells turn malign.

For the first time, I’ve learned about PPIs – Proton pump inhibitors – that made a HUGE change in my life.

Finally, some relief – I took PPIs on an ongoing basis for a while, also changed my eating habits (less flour, mostly).

Now I only take PPIs every few weeks or so if I know I might be up for some reflux (e.g. when I’m invited to a dinner, I know I will be drinking more than usual, especially white whine that always triggers reflux) – I take one up front and I’m fine.

(this might be relevant in a bit).

Stress level and activity;

I’ve been in a “high pressure environment” job-wise for the past 15 years – although I’m not someone who “gets stressed”. I’ve always been a workhorse who “gets stuff done”, I don’t panick when things turn bad, and I’ve always been the guy “when things turn tough”. I always loved challenges. So I wouuld say yes I used to have a lot of stress, but I saw it as a positive thing I managed very well.

I used to be quite active between the ages of let’s say 18-30ish (kickboxing etc.); then when business got more busy and the kids came I got a bit sloppy, on-and-off cardio and weight training depending on how much time I had, but definitely no “gym rat”.

weight (gain & loss); nutrition

As my most recent job required me to travel extensively internationally, I’ve been on a ton of business lunches and dinners and my weight slowly went up from 75kg in my “prime” 10-15 years ago (rock hard muscle, low BF when I was still training and kickboxing actively) to almost 100kg last year.

Lost around 10 kgs but found around 5 of them again :wink: .

Early this year I changed jobs – now way less stress, no more travel, and way more time for the family and myself. Decided to make a change, started to train on a regular schedule (every day I do either cardio or weight training in my home gym – nothing crazy, just solid training. Definitely no overtraining.).

Specifically, wanted to lose belly fat – people never believed me how much I actually weigh because I didn’t look “fat” (more “trained”), but I noticed that I got a huge amount of visceral fat over the past few years that made me go through several iterations of suit fittings and new belts ;-).

Switched to a strict ketogenic diet (I know from my weight losses in the past that low carb works well for me). I eat around 70% fat / 10-15% protein and very little carbs. I combine this with intermittent fasting 16 / 8.

Mostly meat and greens; lots of eggs and dairy. I do not eat any processed food whatsoever, completely cut out all sugar and sugary drinks. Ocassionally, I “cheat” with some fruits.

This works very well for me – I always eat enough (so I’m not “starving myself”), I’m always satiated.
I used to have massive food cravings before lunch (almost couldn’t wait until it’s lunchtime), had lots of “snacks” (sandwiches etc.) in the afternoon to make it to dinner, and lots of late-night snacks. After sports and especially cardio, I felt like I’m starving.

These cravings are all gone – my first food intake is around lunchtime (very fat heavy usually), this makes me very happy for a few hours. I might eat a little bit healthy stuff in the afternoon, and then usually have a big family dinner where I eat “normal” stuff like my family but just cut the rice, pasta, beans or whatever and stick to greens and meat. That’s enough to keep me happy even if I work and stay up late or do sports at night when the family is sleeping. MASSIVE positive change in quality of life, I tell you, and I don’t feel like a miss a lot – more fruits would be nice, but I will re-introduce them gradually when I have reached my target weight. I DO miss nice and crusty self-made bread (sigh) and sometimes a dessert would be nice, but well. Health comes first for the moment :).

I’ve lost almost 18kg now (from 98.7kg which was my max weight, to now 81kg). My target would be 78kg, but speed of weight loss has slowed down and I’m not in a hurry.

Visceral fat is almost gone – no more “pot belly” and feel much better; I have a bit of subcutaneous fat.

I have a scale that measures my Weight, bodyfat, muscle mass etc. and automatically saves it through wlan into an online and iphone app.

According to this scale (taken with a grain of salt, I know these things are not very exact), I went from almost 30% BF at my peak to around 19% BF now, muscle mass went up from 68% to 78%, so the tendency seems to be right.

Supplements

I’ve been actiely supplementing for many years. Here’s what I’ve been taking for quite a while:

Vitamin C: 2000mg / d (buffered)

Vitamin D: 5000 UI / d

Vitamin E: 400IU / d
Vitamin K2: 100ug / d

Magensium: 400mg / d

Zinc: 25mg

Fish Oil: EPA/DHA/GLA: 540/360/30mg / d (6 grams)

Probiotics

B12-Complex (1x p.d.), with:

Thiamin 91mg

Riboflavin 50mg

Niacin 50mg NE

B6 41mg

Folsäure 50ug

B12 5ug

Biotin 50ug

Pantothensäure 69mg

Inositol 75mg

Cholin 75mg

Paraaminobenzoesäure 75mg

Sexual health

Sexual health is nothing I would complain about.

I had an undescended testicle when I was a little boy that was treated with some nasal spray when I was very little. Now both tests are visible. No aching ever.

Sexually active with my wife, I masturbate regularly to fill the gaps ;-).

Everyone is happy although I have the feeling I’m not coming as easily as I used to, and my sperm volume has definitely decreased.

Body temperatures:

I’ve only recently started to measure, but I’m usually around 36.2 – 36.6 C / 97.1 – 97.8 F - after I wake up (measured in-ear, although I always forget right after I get back up and measure when I’m in the bathroom).

During the day, and in the evening I’m between 36.6 – 37C (97.8 – 98.6 F, usually at the lower end).

Alsright, now so now to my lab results and current status.

First check, mid-May 2018:

I go to my GP (which I’ve never met before as I’ve almost never went to a doctor until it’s something really urgent) to get a referral to a dermatologist for a general skin cancer check up.

(I’m well insured / covered but unfortunately my health plan requires me to always see a GP for everything first who then transfers me to a specialist if needed – this is quite stupid but saves me a few hundred bucks each month, and as I usually never have any issues, I chose this plan….). (Skin checkup is fine btw).

Telling about my general tiredness - “I’m healthy”, he says without much of a check. Maybe a little flu or something.

On my suggestion, he gets basic bloodwork done.

Results 28th of May 2018

(values are always: What is tested – ref range – unit – my specific value;
sorry this is in German but I think most should be understandable)

Hämatologie

Erythrozyten 4.2-6.2 10e6/uL - 4.78

Hämoglobin 12-18 g/dL - 15.1

Hämatokrit 36-49 % - 42.9

MCV 85-95 fL - 89.7

MCH 27-33 pg - 31.6

MCHC 32-36 g/dL - 35.2

RDW-SD 37-46 fL - 43.4

RDW-CV 11-16 % - 12.5

Thrombozyten 150-350 10e3/uL - 246

MIttleres Thrombozytenvolumen 8-13 fL - 9.3

**Leukozyten 4-10 10e3/uL - 10.7 (these are leucocytes)

Lymphozyten # 1-4 10e3/uL - 2.2

**Lymphozyten % 25-40 % - 20.7 (these are lymphocytes)

**MXD# 0.2-1 10e3/uL - 1.1

**NEUT# 2-7 10e3/uL - 7.4

MXD% 3-13 % - 10.2

NEUT% 50-70 % - 69.1

Thrombozyten-Verteilungsbreite - 11.5

P-LCR 15-35 % - 21.2

Chemie

Glukose 3.9-6.1 mmol/l - 5.3

HbA1c 3.9-6.1 % - 5.5

Creatinin 35-97 umol/l - 79

Cholesterin 3.88-5.66 mmol/l - 5.38

**Triglycerid 0.56-1.68 mmol/l - 2.04 (triglycerides)

HDL-Cholesterin 0.93-1.78 mmol/l - 1.49

LDL 0-3.0 mmol/l - 2.96

GOT 8-38 U/l - 19

GPT 0-44 U/l - 24

GGT 16-73 U/l - 21

Bilirubin total 2-21 umol/l - 18

ALP 38-126 U/l - 51

Amylase gesamt 37-125 U/l - 75

Harnsäure 149-416 umol/l - 397

Harnstoff 2.9-8.2 mmol/l - 6.57

Creatin Kinase 30-200 U/l - **257

Albumin 38-50 g/l - 46

Vitamin D, 25-OH - 90 (sorry no unit or ref range here)

Vitamin B12 132-835 pmol/l - 198

TSH 0.300-5.000 mU/l - 1.633

Ferritin - 30

GP sends me an email: “All is fine.”

What about the out-of-range values? “Very close to normal range, don’t worry.”

Well, no. I’m tired as hell and have no energy.

I ask to get my testosterone levels checked. GP: “Well, why would you need that, you’re a healthy young man”.

They just wanted to measure free testosterone only (first value), but I asked for prolactin, FSH, LH as well:

Results come in 25th of June –

Total Testosterone 8.6-29.0 nmol/l - 14.8
Prolaktin 4.0-15.3 μg/l - 12.4
FSH 1.5-12.4 U/l - 5.8
LH 1.7-8.6 U/l - 5.1

Doctor says “this is perfectly normal, and you have 3 kids and a beard.”

According to my checks, I’m at the low end of “normal” – yes, technically things would be critical below 8.6nmol (= around 260 ng/dl), but first symptoms of low test can appear below 15nmol/l (my value is 14.8 which equals around 425 ng/dl; remember, this is after massive weight loss, I’m supplementing well with zinc, I exercise, sleep well. )

So I find myself an endocrinologist near where I live (there’s actually only one) – actually a specialist for endocrinology and hormone therapy.

Discussions with endocrinologist – Mid-July

Nice guy who takes a lot of time.

I Explain my whole backstory and issues.

He doesn’t like my leucocyte/lymphocyte values (not bad but too high for being healthy), thinks I have rather low B12 (despite supplementing) and whats to get a better pictures so he orders more tests, also for T.

He makes sure these tests are taken fasted, 8am in the morning.

Lab Results 8th of August:

Dri-Chem

TCHO-P TCHO-P 3.88-5.66 mmol/l - 5.65

TG-P TG-P 0.56-1.68 mmol/l - 0.82

Na-P Na-P 136 - 149 mmol/l - 143

LDL LDL < 3.0 mmol/l - 3.68*

IP-P IP-P 0.84-1.42 mmol/l - 1.42

HDLC-P HDLC-P 0.93-1.55 mmol/l - 1.59*

Cl-P Cl-P 98-106 mmol/l - 105

ALB-P ALB-P 38-50 g/l - 46

Ca-P Ca-P 2.10-2.55 mmol/l - 2.40

CRE-P CRE-P 53-97 umol/l - 73

GLU-P GLU-P 3.9-6.1 mmol/l - 5.5

K-P K-P 3.5 - 4.7 mmol/l - 3.7

HbA1c Hämoglobin <6 % - 4.85

LYM# LYM# 1.0-4.0 10^3/uL - 1.5

MCV MCV 85.0-95.0 fL - 93.1

HGB HGB 12.0-18.0 g/dL - 14.3

PDW PDW 9.0-14.0 fL - 12.9

P-LCR P-LCR 15.0-35.0 % - 27.8

NEUT% NEUT% 50.0-70.0 % - 64.7

LYM% LYM% 25.0-40.0 % - 23.0*

NEUT# NEUT# 2.0-7.0 10^3/uL - 4.3

MXD% MXD% 3.0-13.0 % - 12.3

RDW-CV RDW-CV 11.0-16.0 % - 13.5

RDW-SD RDW-SD 37.0-46.0 fL - 47.8*

MXD# MXD# 0.2-1.0 10^3/uL - 0.8

RBC RBC 4.2-6.2 10^6/uL - 4.47

MPV MPV 8.0-13.0 fL - 10.4

MCH MCH 27.0-33.0 pg - 32.0

MCHC MCHC 32.0-36.0 g/dL - 34.4

HCT HCT 36.0-49.0 % - 41.6

WBC WBC 4.0-10.0 10^3/uL - 6.6

PLT PLT 150-350 10^3/uL - 255

COR Cortisol nmol/l - 271

VIB12 Vitamin B12 > 300 pmol/l - 375

VID25 25-OH Vitamin D3 μg/l - 55.3

TSH TSH 0.51 - 4.3 mU/l - 3.26

FT3 Freies T3 3.93 - 7.7 pmol/l - 4.58

FT4 Freies T4 12.6 - 21.0 pmol/l - 16.9

ZN Zink 10.7 - 23.0 μmol/l - 10.6*

ACTH ACTH 1.3 - 13.9 pmol/l - 2.5

DHEAS DHEAS 1.2 - 8.98 μmol/l - 8.2

TES Testosteron 8.64 - 29.0 nmol/l - 12.9

SHBG SHBG 14.5 - 48.4 nmol/l - 39.6

IGF1 IGF-1 60.8 - 210.7 μg/l - 123.2

(ISSAM Berechnete Testosteron-Fraktionen)

TESFG Freies Testosteron 198.0 - 619.0 pmol/l - 227.7

TESFGP Freies Testosteron 1.53 - 2.88 % - 1.77

TESB Bioverfübg. Testosteron 4.36 - 14.3 nmol/l - 5.6

TESBP Bioverfügb. Testosteron 35.0 - 66.3 % - 43.1

ALB Albumin 35.0 - 52.0 g/l - 45.0

His interpretation:

Cholesterole is fine – I am a bit high on bad and good, but it evens out, and my blood fat is fine.

Despite the fact that I have even lower total test levels this time (227.7 pmol), my free and bioavailable testosterone are “in range” – he said I’m probably just naturally on the low-end of the testosterone range, might be due to my testicle issue as a child.

He would not recommend TRT at all with these values – he said changing my natural hormone system with these values by adding external T would raise me into T levels that are supraphysiological FOR MY BODY, as I was “meant to be with low T” apparently. My DHEAS is rather high, so overall I am fine?

Well, okay.

He IS worried about my low energy though, and wants to dig deeper.

He doesn’t like my Cortisol – it’s wihtin range but rather low, and given that I even had a virus infection at the time I took the blood test, I realised this the next day), it should be higher; also, with low cortisol, my ACTH should be high (they balance out apparently), but that is on the low end as well, which it shouldn’t be.

He suspects ther emight be something iffy with my cortisol production - he ordered a “low-dose synacthen test” for next week, where my cortisol will be measured, then I will be given some stuff that should increase my cortisol, and then measured again to see how my body reacts.

After reading some more, I’ve also asked to measure my estradiol.

My question is – what do you guys think? I’m not complaining about the doc as (unless my GP) he seems to want to really get a full pic of my hormones, but I’m still worried my low test might play a role.

I just want my energy back :frowning: it feels like life is happening and I’m no longer part of it.

Thanks for any help – it would be great if you coul dlet me know if I should ask for additional blood work and ask further questions!!!


#2

EDIT: I forgot to mention one thing. After my first visit to the endocrinologist, I had another (scheduled / check-up) gastrocopy. Everything still the same in terms of damage, but it turns out I have a Helicobacter pylori infection. Suggested treatment with antibiotics (will start in 2 weeks).
Endocrinologist thinks this might be the reason for low B12 and Zinc values, also potentially for my elevated inflammation values in the first bloodwork back in may.

Unrelated to low test / cortisol though.

Just wanted to mention this. :slight_smile:


#3

Do you have any hypothyroid symptoms? Your fT3 is not optimal and your TSH is high. Your free testosterone is low and SHBG is why. I bet you’d feel a lot better if you fixed your thyroid and doubled your test levels.


#4

Most doctors who are not skilled in TRT do not want anything to do with it and will say stupid things just to blow you off and get you out of their office, we hear stories like this all the time.

These doctors aren’t capable of independent thought, you can’t just look at a number and determine someone is normal when the barely have enough energy to do normal everyday things. .

You may be able to have a doctor here consult with a doctor in your country, Dr Crisler and Dr Saya will work with your doctors, you might as well be looking for a TRT specialist on the moon.

An endocrinologist is just a filler doctor and what you need is an anti-aging doctor who has practiced replacing hormones on a regular basis. Most endocrinologists don’t normally do TRT, they mostly do thyroid and diabetes treatments.


#5

Talk to him more indepth and describe all the symptoms you are experiencing. Have you had brain fog? Where do you carry fat on your body at? Around the waist and back? Do you have motivation or desire? What about sex drive, are you experiencing morning wood? Tell him about every single symptom you are having and tell him to treat the SYMPTOMS not a blood panel number. Some guys might feel fine at lower numbers but they are having a negative affect on you. IF he cant treat you and your symptoms, then that tells you the whole story. Tell him to order another set of labs and see if your numbers are similar.

PS. I am not sure if this is allowed on this site, but there are ways to tank your Test levels to make the lab work more in your favor if this Dr only wants to treat your numbers and not the symptoms. Google it. A long night of drinking, with very little sleep, and even shitty unhealthy food could help enough to tank it low enough to get you the help you are wanting. IF TrT is even the help you are looking for.


#6

@all, thanks a lot for your replies, much appreciated! Fully aware it’s a long read :slight_smile:

@highpull looking at the list of symptoms of hypothyroidism, I can check a few - tiring easily, trouble concentrating, sore muscles. The weight gain I had - hmmm, I would probably attest that to my food intake :wink: My endo says thyroid is within range and fine. how would one “fix” that? I read in the thyro sticky that iodine deficiency might be an issue? But then again I read posts from some very active and knowledeable members who say it’s all overstated…

@systemlord thanks a lot. Are you referring to the two doctors from Defy? I’ll see how I can reach out to them and if they do long-distance consults. I’ll also check if I can find some anti-aging specialists over here… Would you say it still make sense to let the endo finish his little battery of tests and exploration to exclude any other issues?

@newbvet thanks for the feedback. I did just that (talking about symptoms), but it seems he wants to keep digging for other hormonal issues… guess that can’t hurt. Good input regarding treating symptoms, not blood levels, though… I’ll bring this up next time. As for whether I’m looking for TRT - with my laymen’s knowledge, it seems to me things are pointing my issues are coming from low TRT. But if other things - fixing thyroid, cortisol, or whatever - fixes my issues, I’m not going to force TRT on myself…


#7

Your TSH is 3.26, should be closer to 1.0. Your brain thinks you need more thyroid. Your fT3 is close to the bottom, should be closer to the top range. You should have reverse T3 checked, it may be high and therefore blocking your fT3.
Thyroid hormone would fix, probably best done with a T3/T4 combo.


#8

Go through the motions and get a diagnosis, it will only help you get treatment even if your doctor misinterprets the results and says you are normal.

You are not fine, your Free T3 is at the bottom of the range and you are expected to not feel good. Most people need Free T3 midrange or better to feel good, your doctor should know this fact.

You can’t make a determination by looking at the numbers, you must also consider symptoms and that’s something most doctors have trouble with doing because their heads are stuck hyperfocusing on lab numbers because it easy.

Triage is the process of determining the priority of patients treatments based on the severity of their condition. A real diagnosis requires deductive reasoning and not everyone is born with these gifts.


#9

@highpull @systemlord had a meeting with the doc today and specifically asked regarding my TSH and FT3 - “everything is fine. TSH and Free T3 even out, aes your TSH might be a higher than 1-2 but the lower-ish FT3 balances it out. No need for further testing.”

Guess I’ll wait until I got the results of the low-dose synacthen test they had me do today, and then see if it’s time to change the doctor…


#10

I do not agree with that.


#11

I can hardly agree with your doctor, clearly being at the bottom of the ranges hormonally has it consequences.

Really what he’s saying is I’m not going to treat you for thyroid because you’re in the normal ranges, his is ignoring symptoms feeding you a bunch of malarkey.

Either find a compassionate doctor to treat you or you can pay for treatment yourself and go private.