T Nation

Hormone Problems/Optimization?

Hello!

I’m hoping for advice on fixing some issues and optimizing my hormones. I have read the sticky on thyroid basics twice, and suspect that I may have an iodine deficiency.

Stats:
Age: 34
Height: 5’11"
Weight: 192 lbs.
Body Fat: 19% (measured by underwater testing)

Symptoms:
-Lethargy (Not all day, every day, but most days, usually around late afternoon/early evening and often lasting until bedtime.)
-Anxiety, Depression, Moodiness (Fairly rare these days, but was once a significant problem for me)
-Brain fog
-Problems concentrating
-Lack of motivation
-Difficulty changing weight, losing or gaining (This has almost always been independent of any calorie intake, activity level, or diet)
-Erection problems (Used to have problems getting one. Seem to have mostly fixed that, but now I can’t always maintain one. Almost never have “morning wood” or experience sexual dreams. Sometimes it is almost as if I can’t feel my penis.)
-Low sex drive (see notes in “Diet” below)
-Dry skin

Diet:
-Has varied off and on. I am currently on the Anabolic Diet. I have been on it for four weeks now. It has helped me drop seven pounds. Based on the mirror, I also believe I have put on a little muscle. It has also done wonders for upping my sex drive and stabilizing my mood, but this doesn’t always stay consistent.

I also did the diet last year, with similar results. However, it took about six months to drop 10 pounds and get to 16% body fat.

Overall, this diet has been the most effective of any methodology I have tried in regards to how I feel overall.

As for diet statistics, I have been eating 3,200 calories/day. I am careful to measure and weigh my food. At this calorie intake, I have dropped seven pounds in four weeks. On weekdays, macro breakdown is approximately 60% fat (almost 50/50 saturated and monounsatured), 38% protein, 2% carbs (< 30/day minus fiber). On weekends, the carbs are upped significantly (mostly clean and Paleo), fat is dropped much lower, and protein is lowered some. I am not as specific about calorie numbers on the weekend, mostly focusing on consuming lots of clean carbs. I consume plenty of green veggies and fiber every day.

I rarely ever use iodized salt, and I don’t consume much in the way of sea vegetables.

Training:
Has varied off and on over the years, sometimes very regularly, other times just to get some exercise in.

Currently, I am following Wendler’s 5/3/1 seriously. Have seen gains in strength and muscle.

Sleep:
Something I have not taken seriously enough in the past. However, for the last six weeks, I have been making sure to get a minimum of eight hours/night. Sometimes 9 to 11 hours. This has helped some with the lethargy and definitely with my mental well being. However, I still often feel tired. I often have trouble getting to sleep, even when I’m tired. And even after a good night’s sleep, I sometimes either still feel tired when I wake up and/or I lack the motivation to get out of bed.

Supplements:
-Multivitamin with good amounts of B, C, D, and E. Includes 150 mcg. iodine.
-Additional 5,000 IU Vitamin D
-I alternate Biotest ZMA and Elitepro Minerals
-SAMe

Body Temp:
I have been taking my temperature for the past four mornings and afternoons. In the mornings, I have been as low as 95.9 and never above 96.6. In the afternoons, I have been as low as 96.9 and never above 98.1.

I have had hyperhydrosis (sweaty hands) all of my life. I occasionally feel hot and have been told that I’m like a heater. Occasionally after eating a low-carb meal, I feel hotter.

Other Notes:
-I have been taking atenolol for high blood pressure for nearly ten years. I started at 50 mg. 2 times/day. I now have that dose down to 25 mg. 2 times/day, and have been at that dosage for about six months. My blood pressure is around 125/75 to 130/80.
-For the past seven days, I have been taking two antibiotics for pneumonia that has mostly cleared up
-I mostly carry fat around the waist
-I do not have hair loss and my facial hair grows easily
-I have often had times of high stress, though recently I feel much better equipped to deal with situations and not end up stressed
-About 10 years ago, I had chronic sinus infections (about one a month), and thus heavy antibiotic use. Now I may get three or four a year, but half the time they go away without antibiotics.

Blood Tests:
I have results from a test done in July 2013. I can post those if they are helpful. I need to get new ones done, but I have to find a new primary doctor first.

Thanks in advance!

And thanks to KSMan for all of the helpful posts! I have learned a lot.

Please post labs.

You are self described iodine deficient. You cannot dig out of that hole with 150mcg per day.
How long have you had that iodine intake?

Thanks for the reply, KSMan!

I’m not sure how long my iodine intake has been like that. I have always taken a multivitamin. My diet has changed over the years (sometimes good, sometimes bad), but seeing as I was either eating out or cooking at home with sea salt, I’m willing to bet that I have not been getting much iodine for years!

My lab results are below. Keep in mind that these are from a little over a year ago. If it makes any difference, I was following the 80/20 rule on diet (80% clean foods, but still high carb, 20% cheat foods). I had not yet tried the Anabolic Diet at that point.

Regarding Vitamin D, I had been taking 7,000 IU/day for at least six months at that point. I don’t spend a lot of time in the sun.

As for cortisol, they had to take seven vials of blood for all of my tests. I started feeling pretty sick while they were doing it, so I don’t know if that would affect my cortisol levels.

I know total testosterone doesn’t mean much, but I still feel like my levels may be low.

LH and FSH [LH/FSH]: Not measured
-Testosterone, Total, Males: 523, Reference Range 241-827 ng/dL
-FT or bio-T: Not measured
-E2: Not measured
-Prolactin: Not measured
-DHT: Not measured
-PSA: Not measured
TSH w/Reflex to FT4: 2.04, Reference Range 0.40-4.50 mIU/L
-T3 no see fT3: Not measured
-T4 no see fT4: Not measured
-Cortisol (blood sample): 19.3, Reference Range for 8 a.m. 4.0-22.0
-Pregnenolone: Not measured
-DHEA: Not measured
-DHEA-S [DHEA Sulphate]: Not measured
-Hematocrit: Not measured
-Cholesterol, total: 248, Reference Range 125-200 mg/dL
-HDL Cholesterol: 58, Reference Range > OR = 40 mg/dL
-Triglycerides: 139, Reference Range < 150 mg/dL
-LDL-Cholesterol: 162, Reference Range < 130 mg/dL
-Chol/HDLC Ratio: 4.3, Reference Range < OR = 5.0 (calc)
-Non-HDL Cholesterol: 190, Reference Range says "Target for non-HDL cholesterol is 30 md/dL higher than LDL cholesterol target
-Vitamin D, 25-Hydroxy, LC/MS/MS Vitamin D, 25-OH, Total: 43, Reference Range 30-100 ng/mL
-Glucose: 82, Reference Range 65-99 mg/dL

TT is middle range. But can’t tell what is going on without FT and E2. If E2 is out of balance, that can lead to symptoms that you have listed. However, functional hypothyroidism can develop the same symptoms. If E2 is elevated, that could be fixed and that could lead to more T.

No doc is going to do anything with TRT with your TT levels.

Suggest that you deal with thyroid and body temperature and perhaps T might improve as well. TSH=2.0 is a significant problem, but most docs are blind to that.

Thanks for the reply!

Once I find myself a new doctor, I will get blood tests done again and order the additional things you ask for.

Based off what I read in your sticky, my TSH level stood out to me. I figured that would be a sign, but wanted your opinion. What does my particular number suggest?

So, am I reading your recommendation correct in assuming that starting iodine replenishment is a good starting point? I read your recommendation of 50 mg./day, but I am a little weary of starting that high. I realize it will take longer, but would 6-12.5 mg./day be enough to start restoring levels? And maybe increasing over time if necessary? Or is that still too low?

Also, do you see any issue with me starting iodine while on antibiotics (clarithromycin and amoxicillin) or blood pressure medication (atenolol)?

Thanks!

Take what your body tolerates. I would not start that low. For me, it took a while before 50mg upset my gut flora. Any issues, you can cut back.

Got it! Some research I have read says that too much iodine can lead to hypothyroidism. I know you have said in previous posts that you think it is actually just bringing forward unknown cases. I’m not questioning your logic, I’m just curious and want to understand more.

Obviously, if it is bringing forward unknown cases, further assessment of one’s condition would be necessary. But IF too much iodine could cause hypothyroidism, do you feel that would be reversible simply by lowering the dose of iodine?

Also, do you see any issue with me starting iodine while on antibiotics (clarithromycin and amoxicillin), blood pressure medication (atenolol), or SAMe?

Does TSH of 2.0 suggest anything in particular? Or just general thyroid issues in the absence of more data?

Thanks!

P.S. I’ve already been discussing some of this with a friend of mine who is going to have their thyroid function checked. Spreading the word!

Possibly iodine could bind to some drugs etc.

Perhaps you can separate high dose iodine from the time when you swallow other drugs.

After antibiotics or high dose iodine, one should take a good probiotic product to rebalance their gut flora.

We know that prolonged iodine deficiency can progress to hyperthyroidism with nodules and sometimes cancer. Pick your poison!

In any case, many restore body temperatures and energy levels with iodine.

Good point on the hyperthyroidism!

Thanks so much for your advice! I will report back once I start IR. Time to go get some iodine!

Since IR can cause transient increases in TSH, how long should one wait completion of IR before having blood work done? I can have blood work done once a year and have my insurance cover it, but I want to make sure the work is representative of the real picture and not transient changes.

Thanks!

Once you are back in maintenance levels of iodine, things should settle down quite soon after that.

Your body temperatures are the bottom line and are in some regards more informative that some thyroid labs.

Thanks, KSMan! I’ll probably wait a week or two after I’m on maintenance dose.

I started IR on September 29 with 25 mg./day total that was divided into two doses. On October 6, I bumped that dose up to 37.5 mg./day total, in three divided doses. This past Sunday, I bumped it up again, this time to 50 mg./day total in three divided doses.

I am noticing some improved energy and I am sleeping more deeply. I still sometimes have trouble getting to sleep though. I also seem to have gotten “morning wood” back. So far, I have not seen an increase in body temps.

In your opinion, do you think my body temps should be going up already? Or is it still too early to tell, seeing as I have only taken in 525 mg. total as of today? My plan is to continue IR until I reach 1 g. Unless you advise otherwise.

Thanks!

I am about 75 mg. away from hitting the 1 g. mark for IR. I have two thermometers that I have been testing with. Depending on which you believe, here are some stats from the last five days:

Lowest Morning Temp: 95.5 (Thermometer 1), 96 (Thermometer 2)
Highest Morning Temp: 96.9 (Thermometer 1), 97.4 (Thermometer 2)

Lowest Afternoon Temp: 96.3 (Thermometer 1), 96.8 (Thermometer 2)
Highest Afternoon Temp: 97.9 (Thermometer 1), 98.4 (Thermometer 2)

Compared to where I started, it seems my afternoon temps have increased slightly. But I’m still not getting to the recommended temps whether morning or night. I have felt slightly better energy. I am sleeping deeply at night, have begun to have vivid dreams, and have had some improvement in the sexual health department. Since I am close to 1 g. total IR and my body temps are still not getting there, is it time to start looking at other things? Or should I continue IR? If so, how much more should I get?

Thanks!

I would stop IR and go to maintenance doses.

Can you get someone else to try the thermometers in the afternoon or early evening to see if they hit 98.6?

Could there be a problem with how you are taking your temperatures?

If the temperature readings are to be trusted, this suggests a deeper problem and lab work would be helpful.
You have eliminated iodine deficiency as a current factor.

Have you any selenium in your supplements? Should!

I will see about having someone else try the thermometers, though I don’t think I’m doing anything wrong on that front.

I am scheduled to get lab work done next month with a new doctor. I can report back on the results then.

My multivitamin has 200 mcg. selenium, and I also take Biotest’s Elite Pro Minerals (which has 200 mcg.) every other day. Plus, I know I eat some selenium containing foods, so I don’t think that is the issue.

I have also been researching the gut biome recently, and have seen anectdotal evidence that addressing problems there with prebiotics, soil-based probiotics, and resistant starch can improve thyroid function and raise low body temperatures. I suspect this could be at least part of the problem, as my immunity is not as good as it could be.

And I had a period of life in which I had to take a lot of antibiotics. And I know high-dose iodine can contribute to killing off gut bacteria. So I might try shoring that up. Thoughts?