T Nation

Help Interpreting Results..


#1

History: no trt, did a few prohormone cycles over the course of the last 4 years, with the most recent being sep 09. all were followed with proper pct and all saw the boys bounce back to normal. sustained some level of concussion oct 09 after a hard landing in airborne school (loss of consciousness for a couple minutes, spotty memory of the hours after the incident, and i repeated statements/questions over and over.). I have a hard as hell time putting on mass and strength, and an equally hard time taking off the fat while keeping lbm (~15% at 205 right now). Only supps I was taking for the 3 weeks preceding the test were multi, fish oil, vitamin b complex, and 5000iu Vitamin d-3. Energy, libido, and overall mood are ok but I feel like they could be much better.

Age: 29
TSH: 2.320 (0.450-4.500)
T4: 10.7 (4.5-12.0)
T4 Free: 1.5 (0.82-1.77
T3: 3.0 (2.0-4.4)
Reverse T3: 346 (90-350) (???)
fwiw, I had taken my waking temperature daily for 10 days preceding the test. Mean was 97.81 with a high of only 98.2 and low of 97.3.
Ferritin: 84 (30-400)

Vitamin B12: >1999 (211-946)
Vitamin D: 28.7 (32.0-100.0) (I've since tripled my daily dosage)
IGF-1: 214 (117-329)

LH: 6.3 (1.7-8.6)
FSH: 1.4 (1.5-12.4) (concerns me...I'd like to have kids in the next 3-5 years)

Total Test: 420 (280-800) (pretty much right around where i was expecting, which prompted getting these tests done)
Free Test: 9.8 (9.3-26.5) (barely within range...high SHBG? in which case nettle root might be a good idea?)
DHEA-S: 264.7 (160-449)
Estradiol: 13.2 (7.6-42.6)
DHT: 44 (30-85)
Pregnenolone: 133 (<151)
Progesterone: 0.6 (0.2-1.4)

Waiting on ZRT 4-hormone kit that I'll be using to test cortisol.
Prolactin not tested (wishing I had ordered that as well though)

2 things are throwing me off with this:
a) estradiol at 13.2 is a good level, if maybe a bit low, correct? I'm used to seeing results with low test and high estradiol, so I'm confused with that result.
b) low fsh with normal lh. If I had a pituitary issue wouldn't both be low? Why would FSH be rock bottom with LH normal?

I could use some help interpreting these results. TIA


#2

E2 is low because there is not much free T to be aromatized to E2, that is ok. You might do a bit better [mental] with more absolute E2, but the T:E2 ratio is somewhat favorable relative to your low T levels.

With low E2, SHBG will not be high.

LH and fT are released in pulses and what shows up on the lab is a matter of timing. The absolute levels are not too meaningful. FSH has a longer half life and is a better measure of gonadotrophin output than LH. Your FSH=1.4 tells the story.

If you have your pituitary scanned, there may be evidence of physical damage; which can lead to hypogonadism.

Any reduction in peripheral vision?

Are you in the military now?

You might be a little hyperthyroid - based on your T4 numbers. Does your neck appear thick where the thyroid is? Any lumps there? Are you heat intolerant? How has that changed? What is your body temp in the day time? It is a little bit odd to have TSH=2 with higher T4 levels.

rT3 is a concern and perhaps your cells are not getting enough T3 activation. We need hardasnails to comment on this.

Is your Vit-D3 oil based? Do not take with high fiber meals.


#3

welcome on board and good luck.

First guess - i believe you have a cortisol problem.

low cortisol = low conversion of T4 to free T3 and high conversion of T4 to Reverse T3.

Your Reverse T3 is completely canceling out your free T3. You have a pretty good doc - it is rare to find one that knows about Reverse T3 yet alone tests for it right off the bat. check out stopthethyroidmadness for more info on RT3.

Your RT3 should be 1/3 of your (free T3 * 10).

once you fix your cortisol problem, your thyroid function should improve dramatically, and once cortisol and thyroid are fixed your Testosterone MAY readjust as well.

I would wait and try and fix those first before jumping into HRT.

post your cortisol numbers when you get them.


#4

just realized i hadn't included my age: i'm 29

thanks for your input. I wasn't aware of the timing issue and how FSH would be a better indicator. It makes more sense now.

Peripheral vision is great and has been unchanged.

No longer in the military.

Hyperthyroid? That would be surprising. Neck is not thick or swollen (even slightly) and there are no lumps or tenderness in the area. I tolerate the heat well and that hasn't changed. I didn't track my day time temp but I will start doing so. I did take it a few times during those 10 days that I tracked waking temp and it was usually only very slightly above waking temp. FWIW, in light of the results of Reverse T3, I have been supplementing over the past week with Thyroid Energy by NOW. Doing so brought my average waking temp up to 98.3 over the past 6 days with a range of 98.1-98.5. Would it be advisable to stop this?

Vitamin D3 is oil based and I wasn't aware about the fiber....I'll be sure to separate the two as much as possible.


#5

I had these tests done on my own through LEF based on the sticky thread here. I wanted to skip the bullshit with docs that half-ass this stuff. Speaking of which I intend on getting in contact with hardasnails. As I understand it he works with or knows of a good doc in eastern PA, which would be great because I'm in NJ just outside of Philly.

Yeah I had come across cortisol as being the "blocker" in T4-> T3 so what you say makes sense. Any recommendations for cortisol supps? I have endoamp on hand...

And agreed on waiting for the TRT, despite hating the fact that I hate how my body responds (or doesn't, as the case is) to stimulus that others seem to respond to so well. I'd like to avoid it if possible, and hopefully correcting cortisol or other issues would improve my numbers. Still though, FSH is a personal concern of mine that definitely needs to be rectified.

edit: noticed on stopthethyroidmadness.com that ferritin can come into play with RevT3. Lab was 84 with a ref range of 30-400.


#6

What was AM body temp B4 Thyroid Energy?

Thyroid Energy appears to be a good source of trace elements and iodine. Do you feel any changes?

PureChance has some good ideas. How do you react to stress? Any other injuries, illnesses or infections? Do you run out of energy during the day? Your cortisol kit results will be interesting.

Age?

Any Rx or OTC drugs?

Extremes of diet?


#7

I'm 29, no prescriptions or OTC drugs at all.

AM temps prior to the test and thyroid energy was 97.81.

Actually, yes I have noticed a bit of an improvement after starting the supplement. I feel hotter and have a slight but enought to notice increase in overall energy throughout the day.

Extremes of diet: possibly?...I did lyle's rapid fat loss handbook back in Feb and in July. 6 days vlc high protein, followed by 1 refeed day. Prior to July (for the preceding 3 months or so) and for August it's been carb cycling.


#8

Occured to me that I hadn't answered your other questions:

stress reactions: depends; sometimes I handle it with ease, other times I can go into mini-rage.
injuries/illness/infections: none in the last 5+ months
run out of energy: lately, yes. Right around this time of day, I'll sometimes just feel drained and feel like going to bed.

today i'm taking the samples for cortisol. I'm eager to see the results, as some of my research is starting to hint at cortisol being the issue, as PureChance suggested....will post results


#9

Take cortisol early in the day, not later as you need to wind down at night.


#10

what type of samples? supplements, Cortef, compounded HC?

What dosage? When do you take it?

Cortisol can be tricky + anytime you introduce something to your system there are possible unforseen interactions with multiple systems.

Other people are experimenting with Lipid Matrix Pregnenolone to boost Cortisol production. Oral Pregnenolone goes through the first pass liver process and can get converted to something else which can have an excessive valium-like effect (i.e. - mental fog).

I have heard that Ferritin of 150 is ideal, but you have to be careful and also watch RBC, Hemoglobin, and Hematocrit. I can only get my ferriting up to 60 from 30 because that also pushes my other blood levels to borderline maximum levels.


#11

no i'm referring to testing for cortisol levels through the day. i have the zrt saliva test. i'm not taking anything for cortisol control until i have the results from zrt back.


#12

ahhh, not what I first read/thought.

That is good, I was worried for you there.


#13

Well, PureChance, looks like you were spot on...finally got my ZRT cortisol results back:

morning: 2.6 (3.7-9.5)
noon: 2.9 (1.2-3.0)
evening: 1.1 (0.6-1.9)
night: 0.4 (0.4-1.0)

I'm sure both you guys are aware, but to reiterate what was reported as the summary in the report, basically it's pointing at adrenal exhaustion.

So where do I go from here? I have a couple bottles of Endoamp ready to go, but I'm wondering if that's appropriate right now? What can I do to try to get my adrenals/cortisol back in order?


#14

herbal supplements, etc. generally do not work (based on all of the forum posts I have read).

I would suggest talking with a doctor about getting on Hydrocortisone Compounded or Cortef. Start off slow 5mg a week, and then increase 5mg every other week until you get to 20 - 30 mg a day.

stopthethyroidmadness.com has a good section on adrenal fatigue and dosage recommendations, timing, increases, etc.

I am on 15mg Compounded Slow Release HC a day. Tried 20mg but it kept me up at night and didn't feel good on that amount. I am thinking about trying regular release with more frequent doses when I go in for a refill.

extra HC can also downregulate Testosterone and increase Thyroid conversion of T4 to free T3.

after several months you can see if your system has rebalanced itself by slowly going back off the medications and see if your system can pick up the slack. Some can do this, others have to stay on HC for their entire life.


#15

Not easy, you need to take charge, a good doc can help, many are clueless, no quick fix.

You need to read the book, attempting to cover this issue in a post is not going to work.

How was the day that you did the 4 sample cortisol? A normal stressful day or on a relaxing weekend?
What time of day do you run out of energy?
Did you feel that way the day that you did the test?

You need to build up your adrenals, get tR3 down. You could start TRT, but you need thyroid and adrenal status that will support this. The odd thing is that waking body temp indicates a decent thyroid status. And your DHEA-S is not bad, suggesting that adrenal problems might not be severe. However, I am definitely not familiar with rT3 recovery issues.